Fluorophores use in pituitary surgery: A pharmacokinetics and pharmacodynamics appraisal

Daniele Bongetta, Fulvio Tartara, Fabio Pagella, Teresa Somma, Marilou Cavaliere, Giuseppe Di Perna, Francesco Zenga, Fabio Cofano, Diego Garbossa, Cesare Zoia

Research output: Contribution to journalArticlepeer-review

Abstract

(1) Background: Despite many surgical and technological advances, pituitary adenoma surgery is still burdened by non-negligible rates of incomplete tumor resection, mainly due to difficulties in differentiating pathology from normal pituitary tissue. Some fluorescent agents have been recently investigated as intraoperative contrast agents in pituitary surgery. The aim of this study is to evaluate the actual knowledge about the usefulness of such fluorophores with a particular focus on both the pharmacokinetics and pharmacodynamics issues of the pituitary gland. (2) Methods: We reviewed the current literature about fluorophores use in pituitary surgery and reported the first fully endoscopic experience with fluorescein. (3) Results: The studies investigating 5-ALA use reported contrasting results. ICG showed encouraging results, although with some specificity issues in identifying pathological tissue. Low-dose fluorescein showed promising results in differentiating pathology from normal pituitary tissue. Apart from the dose and timing of administration, both the fluorophores’ volume of distribution and the histological variability of the interstitial space and vascular density played a crucial role in optimizing intraoperative contrast enhancement. (4) Conclusions: Both pharmacokinetics and pharmacodynamics issues determine the potential usefulness of fluorophores in pituitary surgery. ICG and fluorescein showed the most promising results, although further studies are needed.

Original languageEnglish
Article number565
JournalBrain Sciences
Volume11
Issue number5
DOIs
Publication statusPublished - May 2021

Keywords

  • 5-ALA
  • Fluorescein
  • ICG
  • Pituitary surgery

ASJC Scopus subject areas

  • Neuroscience(all)

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