Intraoperative determination of nerve location

Abstract

The invention provides methods for intraoperatively determining the location of nerves by use of fluorescent dyes. The methods are particularly useful for locating the cavernous nerves innervating the penis.

1 : A method of determining the location of a nerve or portion of a nerve of interest in a subject during a surgical operation, comprising:
 a) prior to said surgical operation, administering to an organ or area of said subject innervated by said nerve or portion of a nerve of interest a dye which fluoresces at an emission wavelength when said dye is contacted with an excitation wavelength, whereby said dye is taken up by or proceeds along the path of said nerve;   b) exposing said nerve or portion of nerve during said operation to illumination comprising said excitation wavelength, thereby causing said fluorescent dye in or along the nerve or portion thereof to fluoresce;   c) detecting the fluorescence of said dye, thereby determining the location of said nerve or portion of nerve during said surgical operation.   
     
     
         2 - 22 . (canceled) 
     
     
         23 : A method of  claim 1 , wherein said dye is injected into a cavernous body of the penis. 
     
     
         24 : A method of  claim 23 , wherein said injection into said cavernous body is into a crus of said cavernous body. 
     
     
         25 : A method of  claim 1 , wherein said dye is injected by epidural injection. 
     
     
         26 : A method of  claim 1 , wherein said nerve is transected during the surgical operation, creating two ends, and the detection of fluorescence of step (c) is used to determine the location of the two ends. 
     
     
         27 : A method of  claim 26 , wherein said determination of the location of the two ends is used to guide grafting of nerve tissue between the ends or to reconnect them. 
     
     
         28 : A method of  claim 1 , wherein said determination of the location of 2 said nerve is used to avoid transecting said nerve. 
     
     
         29 : A method of  claim 28 , wherein said surgical operation is a radical prostatectomy. 
     
     
         30 : A method of  claim 29 , wherein said nerve is a cavernous nerve. 
     
     
         31 : A method of  claim 1 , wherein said nerve or said portion of said nerve is visualized on a image display, thereby permitting determination of the location of said nerve or portion of said nerve. 
     
     
         32 : A method of  claim 1 , wherein said exposing of said nerve to excitation wavelength is by a laparoscopic instrument. 
     
     
         33 : A method of  claim 1  wherein said dye is a dye which fluoresces when exposed to near infrared light. 
     
     
         34 : A method of  claim 1 , wherein said dye is a tricarbocyanine dye or an analog thereof. 
     
     
         35 : A method of  claim 34 , wherein the tricarbocyanine dye is indocyanine green. 
     
     
         36 : A method of  claim 1 , wherein the subject is a human. 
     
     
         37 : A method of  claim 1 , wherein said dye is administered between 1 hour and 30 hours before said surgical operation. 
     
     
         38 : A method of  claim 1 , wherein said dye is administered between about 18 hours and about 24 hours before said surgical operation. 
     
     
         39 : A method of  claim 1 , wherein said dye is administered between about 6 hours and about 24 hours before said surgical operation. 
     
     
         40 : A method of  claim 30 , wherein the nerve is the small cavernous nerve. 
     
     
         41 : A method of  claim 30 , wherein the nerve is the large cavernous nerve.