Hoehne, Julius and Acerbi, Francesco and Falco, Jacopo and Akcakaya, Mehmet Osman and Schmidt, Nils Ole and Kiris, Talat and de Laurentis, Camilla and Ferroli, Paolo and Broggi, Morgan and Schebesch, Karl-Michael (2020) Lighting Up the Tumor-Fluorescein-Guided Resection of Gangliogliomas. JOURNAL OF CLINICAL MEDICINE, 9 (8): 2405. ISSN , 2077-0383
Full text not available from this repository. (Request a copy)Abstract
(1) Background: Gangliogliomas comprise a small number of brain tumors. They usually present as World Health Organization (WHO) grade I, and they delineate on gadolinium-enhanced MRI; the surgical goal is wide radical resection, and the course thereafter is usually benign. Fluorescein sodium (FL) tends to accumulate in areas with altered blood-brain barrier (BBB). Thus far, the results provided by prospective and retrospective studies show that the utilization of this fluorophore may be associated with better visualization and improvement of resection for several tumors of the central nervous system. In this study, we retrospectively studied the effect of fluorescein sodium on visualization and resection of gangliogliomas. (2) Methods: Surgical databases in three neurosurgical departments (Regensburg University Hospital; Besta Institute, Milano, Italy; and Liv Hospital, Istanbul, Turkey), with approval by the local ethics committee, were retrospectively reviewed to find gangliogliomas surgically removed by a fluorescein-guided technique by the aid of a dedicated filter on the surgical microscope from April 2014 to February 2020. Eighteen patients (13 women, 5 men; mean age 22.9 years, range 3 to 78 years) underwent surgical treatment for gangliogliomas during 19 operations. Fluorescein was intravenously injected (5 mg/kg) after general anesthesia induction. Tumors were removed using a microsurgical technique with the YELLOW 560 Filter (YE560) (KINEVO/PENTERO 900, Carl Zeiss Meditec, Oberkochen, Germany). (3) Results: No side effects related to fluorescein occurred. In all tumors, contrast enhancement on preoperative MRI correlated with bright yellow fluorescence during the surgical procedure (17 gangliogliomas WHO grade I, 1 ganglioglioma WHO grade II). Fluorescein was considered helpful by the operating surgeon in distinguishing tumors from viable tissue in all cases (100%). Biopsy was intended in two operations, and subtotal resection was intended in one operation. In all other operations considered preoperatively eligible, gross total resection (GTR) was achieved in 12 out of 16 (75%) instances. (4) Conclusions: The use of FL and YE560 is a readily available method for safe fluorescence-guided tumor resection, possibly visualizing tumor margins intraoperatively similar to contrast enhancement in T1-weighted MRI. Our data suggested a positive effect of fluorescein-guided surgery on intraoperative visualization and extent of resection during resection of gangliogliomas.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | SURGICAL MICROSCOPE FILTER; CENTRAL-NERVOUS-SYSTEM; SODIUM FLUORESCEIN; BRAIN; GLIOMAS; ganglioglioma; fluorescein sodium; YELLOW 560 nm filter; fluorescence-guided surgery; PENTERO 900; KINEVO; surgical microscope; neurosurgery |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurochirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 17 Mar 2021 09:46 |
| Last Modified: | 17 Mar 2021 09:46 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44079 |
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