PDF icon PDF herunterladen
Open Access
CC BY 4.0 · European J Pediatr Surg Rep. 2025; 13(01): e23-e30
DOI: 10.1055/a-2646-8880
Case Report

Advancing Neuroblastoma Surgery through the Clinical Integration of Virtual Reality and Indocyanine Green Fluorescence-Guided Imaging: A Case Report

Irene Paraboschi
1   Department of Biomedical and Clinical Science, University of Milan, Milan, Lombardy, Italy
2   Department of Pediatric Surgery, “V. Buzzi” Children's Hospital, Milano, Italy
,
Ugo M. Pierucci
2   Department of Pediatric Surgery, “V. Buzzi” Children's Hospital, Milano, Italy
,
Elena Di Blasi
3   Soft Tissue Tumor Pathology Unit, Department of Advanced Diagnostics, Fondazione IRCSS Istituto Nazionale dei Tumori, Milano, Italy
,
Paola Collini
3   Soft Tissue Tumor Pathology Unit, Department of Advanced Diagnostics, Fondazione IRCSS Istituto Nazionale dei Tumori, Milano, Italy
,
Marta Podda
4   Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
,
Giovanna Gattuso
4   Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
,
Roberto Luksch
4   Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
,
Francescco Rizzetto
5   Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
6   Postgraduate School of Diagnostic and Interventional Radiology, University of Milano, Milano, Italy
,
Alice M. Munari
7   Department of Pediatric Radiology, “V. Buzzi” Children's Hospital, Milano, Italy
,
Cristina Gallotta
8   CIMaINa - Interdisciplinary Centre for Nanostructured Materials and Interfaces, University of Milano, Milano, Italy
,
Tommaso Santaniello
8   CIMaINa - Interdisciplinary Centre for Nanostructured Materials and Interfaces, University of Milano, Milano, Italy
,
Maurizio Vertemati
8   CIMaINa - Interdisciplinary Centre for Nanostructured Materials and Interfaces, University of Milano, Milano, Italy
2   Department of Pediatric Surgery, “V. Buzzi” Children's Hospital, Milano, Italy
,
Paolo Milani
8   CIMaINa - Interdisciplinary Centre for Nanostructured Materials and Interfaces, University of Milano, Milano, Italy
9   Department of Physics “Aldo Pontremoli,” University of Milano, Milano, Italy
,
Gloria Pelizzo
1   Department of Biomedical and Clinical Science, University of Milan, Milan, Lombardy, Italy
2   Department of Pediatric Surgery, “V. Buzzi” Children's Hospital, Milano, Italy
› Institutsangaben
Funding This work was supported within the Multilayered Urban Sustainability Action (MUSA)– project, funded by the European Union—NextGenerationEU, under the National Recovery and Resilience Plan (NRRP) Mission 4 Component 2 Investment Line 1.5: Strengthening of research structures and creation of R&D “innovation ecosystems,” set up of “territorial leaders in R&D.” We gratefully acknowledge the Foundation Romeo and Enrica Invernizzi and Leonardo LoCascio Foundation for supporting this project. We also thank the APC Central Fund of the University of Milano for its assistance.
› Weitere Informationen
Auch verfügbar aufeRef
  Lizenzen und Reprints
Preview

Abstract

Background

Neuroblastoma, the most common extracranial solid tumor in children, requires meticulous surgical interventions due to its complex anatomical location and proximity to vital structures. Emerging technologies, such as virtual reality (VR) and indocyanine green (ICG) fluorescence-guided imaging, offer promising solutions to enhance surgical precision and outcomes. Despite their potential, their use in pediatric oncology remains underexplored. This case report highlights the integration of VR and ICG fluorescence imaging in the surgical treatment of neuroblastoma, emphasizing their benefits, limitations, and the need for further advancements.

Case Description

A 12-month-old female with a prenatal diagnosis of cloacal malformation, Müllerian anomalies, and a horseshoe kidney was under care at our center for the management of her complex urogenital anomalies. During preoperative imaging to plan her reconstructive surgery, an abdominal MRI revealed a solid retroperitoneal mass, later confirmed as a right adrenal neuroblastoma. After six cycles of chemotherapy, metaiodobenzylguanidine (mIBG) scans indicated persistent uptake, suggesting the possible presence of tumor viability. Consequently, a definitive surgical resection was scheduled. The procedure incorporated VR for navigation and ICG fluorescence for real-time vascular mapping, facilitating precise dissection and preservation of critical structures. The patient's postoperative recovery was uneventful, and she was discharged in stable condition. Follow-up evaluations (i.e., MRI, mIBG) showed no evidence of residual macroscopic disease.

Conclusion

VR and ICG fluorescence imaging hold promise for enhancing surgical precision and safety in pediatric neuroblastoma. While current limitations include the lack of real-time image overlay and inadequate visualization of tumor margins, future advancements in navigation systems and targeted probes may overcome these barriers and significantly improve oncologic outcomes.

Keywords

neuroblastoma - virtual reality - indocyanine green

Patients' Consent

Consent for publication was obtained from the patient's legal guardian, ensuring compliance with ethical and legal standards for the dissemination of identifiable information.




Publikationsverlauf

Eingereicht: 03. Mai 2025

Angenommen: 21. Juni 2025

Accepted Manuscript online:
02. Juli 2025

Artikel online veröffentlicht:
24. Juli 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany