KARL STORZ Launches New 4 mm Endoscopic NIR/ICG Fluorescence Imaging System to Enhance Minimally Invasive Neurosurgery

06/12/2018 | Human Medicine

System Provides Real-Time Endoscopic Visible and Near-Infrared Fluorescence Imaging

El Segundo CA (December 6, 2018) – KARL STORZ Endoscopy-America, Inc., a leader in endoscopy, imaging and operating room integration solutions, is pleased to announce the launch of NIR/ICG Fluorescence Imaging, an IMAGE1 S™ technology.

The only FDA-cleared ICG technology for endoscopic neurosurgery in a 4 mm format, the KARL STORZ NIR/ICG Imaging System assists surgeons in making critical decisions that may reduce the occurrence of costly complications. It is a tool that is creating a new standard of care in minimally invasive neurosurgery. KARL STORZ will launch the 4 mm NIR/ICG Imaging System during the 2018 CNS Meeting at Booth 1135 in the George R. Brown Convention Center in Houston, TX.

The KARL STORZ NIR/ICG Imaging System enables live visualization of structural landmarks beneath the tissue surface, with no latency, using near-infrared (NIR) imaging to detect indocyanine green (ICG), an optical imaging agent administered to the patient during the procedure.  

Neurosurgeons can benefit from enhanced visualization of patient anatomy using NIR imaging to detect ICG distribution in tissue. This enables intraoperative evaluation of tissue perfusion and vascularization, identification of critical neurovascular structures, and differentiation of tissue planes between lesions and adjacent structures.

During a recent presentation to the North American Skull Base Society, Paul Gardner, MD, Department of Neurologic Surgery, University of Pittsburgh Medical Center, described the potential of NIR/ICG technology to help neurosurgeons accurately assess viability of vascularized intranasal flaps, which are a primary option for endoscopic reconstruction of skull-base defects.1

“Our study evaluated the efficacy of ICG near-infrared endoscopy in predicting viability of local, pedicled intranasal flaps during endoscopic endonasal surgery of the skull base,” said Gardner. “Results of the study indicated that intraoperative evaluation of flap perfusion with ICG near-infrared imaging is both feasible and accurate at predicting post-operative MRI flap enhancement. ICG enhancement of both the flap body and pedicle was associated with a 100% rate of postoperative MRI-enhancement and zero cases of flap necrosis.”1

Looking ahead, the researchers concluded, “Enhancement of the flap pedicle seems to be the most important predictor of successful reconstruction. ICG near-infrared endoscopy may prove to be a useful tool for the prevention and management of reconstructive complications.”1

The technology has been found to offer other key benefits in clinical use. Publications have demonstrated, for example, that ICG endoscopy has the potential to significantly reduce errors by facilitating identification of critical vascular structures and can be a useful auxiliary tool in differentiating tumors from adjacent structures.2 And using endoscopic ICG video angiography during microsurgical clipping of an intracranial aneurysm has been found to provide additional information in 42.3% of cases that could not otherwise be obtained via microscopic ICG video angiography. Because of endoscopic ICG direct continuous visualization, this method increases the safety and durability of the aneurysmal clipping.3

Key components of the KARL STORZ NIR/ICG Imaging System include: our 4 mm rigid NIR/ICG neuroendoscopes, in 0°, 30° and 45° for visible white light (VIS) and NIR illumination and imaging, the D-LIGHT P 300W Xenon light source with foot pedal for easy switching between white light and NIR mode for optimal work flow efficiency, a color HD video camera head capable of capturing both VIS and NIR imaging, a fiber-optic light cable, and KARL STORZ ICG Kit.

KARL STORZ Endoscopy-America, Inc., is an affiliate of KARL STORZ SE & Co. KG, an international leader for more than 70 years in reusable endoscope technology, encompassing all endoscopic specialties. Based in Tuttlingen, Germany, KARL STORZ SE & Co. KG is a family-owned company that designs, engineers, manufactures, and markets all its products with an emphasis on visionary design, precision craftsmanship and clinical effectiveness. For more information, call (800) 421-0837 or visit the company’s Web site at


1GARDNER P, GELTZWEILER M, NAKASSA ACI, et al. Evaluation of Intranasal Flap Perfusion by Intraoperative ICG Fluorescence Angiography. Paper presented at: North American Skull Base Society Annual Meeting, 2017; New Orleans, LA.

2NAKASSA ACI, WANG EW, FERNANDEZ-MIRANDA JC, et al. Usefulness of Indocyanine Green Fluorescence Endoscopy for Intraoperative Differentiation of Intracranial Tumors and Adjacent Structures. J Neurol Surg B. 2017; 78(S 01): S1-S156. doi: 10.1055/s-0037-1600677

3YOSHIOKA H, KINOUCHI H. The Roles of Endoscope in Aneurysmal Surgery. Neurol Med Chir (Tokyo). June 2015;55(6):469-478. doi:  10.2176/nmc.ra.2014-0428