Abstract：
Second Window Indocyanine Green (SWIG) is a novel intraoperative imaging technique that uses near-infrared (NIR) light for intra-operative tumor visualization using the well-known fluorophore indocyanine green (ICG). Because schwannomas often incorporate the nerve into the encapsulated tumor and impinge on surrounding neural structures, SWIG is a promising technique to improve tumor resection while sparing the nerve.
To demonstrate the use of SWIG in resection of cranial nerve schwannomas.
Three patients with cranial nerve schwannomas (i.e., trigeminal, vestibular, and vagus) underwent SWIG-guided resection. During surgery, NIR visualization was used intermittently used to detect fluorescence to guide resection. Signal-to-background ratio was then calculated to quantify fluorescence.
Patients were infused with ICG at a dose of 5.0 mg/kg 24 hours before surgery. Each patient achieved total or near-total resection and relief of symptoms with lack of recurrence at six-month follow-up. The average SBR calculated was 3.79, comparable to values for SWIG-guided resection of other brain and spine tumors.
This case series is the first published report of trigeminal and vagus nerve schwannoma resection using the SWIG technique and suggests that SWIG may be used to detect all schwannomas, alongside many other types of brain tumor. This paper also demonstrates the importance of preoperative ICG infusion timing and discusses the inverse pattern of NIR signal that may be observed when infusion occurs outside of the optimal timing. This provides direction for future studies investigating the administration of SWIG to resect cranial nerve schwannomas and other brain tumors.
To demonstrate the use of SWIG in resection of cranial nerve schwannomas.
Three patients with cranial nerve schwannomas (i.e., trigeminal, vestibular, and vagus) underwent SWIG-guided resection. During surgery, NIR visualization was used intermittently used to detect fluorescence to guide resection. Signal-to-background ratio was then calculated to quantify fluorescence.
Patients were infused with ICG at a dose of 5.0 mg/kg 24 hours before surgery. Each patient achieved total or near-total resection and relief of symptoms with lack of recurrence at six-month follow-up. The average SBR calculated was 3.79, comparable to values for SWIG-guided resection of other brain and spine tumors.
This case series is the first published report of trigeminal and vagus nerve schwannoma resection using the SWIG technique and suggests that SWIG may be used to detect all schwannomas, alongside many other types of brain tumor. This paper also demonstrates the importance of preoperative ICG infusion timing and discusses the inverse pattern of NIR signal that may be observed when infusion occurs outside of the optimal timing. This provides direction for future studies investigating the administration of SWIG to resect cranial nerve schwannomas and other brain tumors.
摘要：
背景：第二窗口吲哚菁绿（SWIG）是一种新颖的术中成像技术，使用近红外（NIR）光进行术中肿瘤可视化，使用众所周知的荧光团吲哚菁绿（ICG）。因为神经鞘瘤通常会将神经整合到包裹的肿瘤中并撞击周围的神经结构，SWIG是一种有前途的技术，可以改善肿瘤切除，同时保留神经。
目的：证明SWIG在脑神经鞘瘤切除中的应用。
方法：三例脑神经鞘瘤患者（即，三叉神经,前庭,和迷走神经）接受SWIG引导切除。手术期间,间歇地使用NIR可视化来检测荧光以指导切除。然后计算信号背景比以定量荧光。
结果：患者在手术前24小时以5.0mg/kg的剂量输注ICG。在6个月的随访中，每位患者均实现了完全或接近完全的切除，症状缓解，没有复发。计算的平均SBR为3.79，与SWIG引导切除其他脑和脊柱肿瘤的值相当。
结论：本病例系列是首次发表的使用SWIG技术切除三叉神经和迷走神经神经鞘瘤的报告，表明SWIG可用于检测所有神经鞘瘤，和许多其他类型的脑肿瘤一样.本文还证明了术前ICG输注时机的重要性，并讨论了在最佳时机之外进行输注时可能观察到的NIR信号的反向模式。这为将来研究SWIG切除颅神经鞘瘤和其他脑肿瘤的研究提供了方向。
目的：证明SWIG在脑神经鞘瘤切除中的应用。
方法：三例脑神经鞘瘤患者（即，三叉神经,前庭,和迷走神经）接受SWIG引导切除。手术期间,间歇地使用NIR可视化来检测荧光以指导切除。然后计算信号背景比以定量荧光。
结果：患者在手术前24小时以5.0mg/kg的剂量输注ICG。在6个月的随访中，每位患者均实现了完全或接近完全的切除，症状缓解，没有复发。计算的平均SBR为3.79，与SWIG引导切除其他脑和脊柱肿瘤的值相当。
结论：本病例系列是首次发表的使用SWIG技术切除三叉神经和迷走神经神经鞘瘤的报告，表明SWIG可用于检测所有神经鞘瘤，和许多其他类型的脑肿瘤一样.本文还证明了术前ICG输注时机的重要性，并讨论了在最佳时机之外进行输注时可能观察到的NIR信号的反向模式。这为将来研究SWIG切除颅神经鞘瘤和其他脑肿瘤的研究提供了方向。
