Preoperative Intravenous Indocyanine Green Injection Demarcates Tumor Border and Adjacent Nerves in Surgical Resection of Posterior Mediastinal Neurogenic Tumors.

OBJECTIVES

To assess the application of preoperative indocyanine green (ICG) near-infrared (NIR) fluorescence imaging in video-assisted thoracoscopic surgery (VATS) for posterior mediastinal neurogenic tumors.

METHODS

We present a case of a 66-year-old female with a T3-adjacent posterior mediastinal tumor. She received intravenous ICG (5 mg/kg) 24 hours before surgery. Intraoperative NIR imaging was used to identify the tumor and nearby nerves during VATS.

RESULTS

ICG fluorescence clearly delineated the tumor margins and visualized the adjacent sympathetic and intercostal nerves. This guided the complete resection of the tumor, which extended into the intervertebral foramen, with no postoperative complications. Pathology confirmed a schwannoma.

DISCUSSION: ICG NIR imaging offers enhanced intraoperative visualization for complex posterior mediastinal tumors. It aids in distinguishing tumor from normal tissue and identifying key nerves, thereby facilitating complete resection while minimizing the risk of iatrogenic injury. This technique shows promise for managing "dumbbell" tumors via a minimally invasive approach.

CONCLUSION

Preoperative ICG injection is a useful adjunct in VATS for posterior mediastinal tumors, improving the delineation of tumor borders and neural structures to enhance surgical precision and safety.