Hoehne, Julius and Hohenberger, Christoph and Proescholdt, Martin and Riemenschneider, Markus J. and Wendl, Christina and Brawanski, Alexander and Schebesch, Karl-Michael (2017) Fluorescein sodium-guided resection of cerebral metastases-an update. ACTA NEUROCHIRURGICA, 159 (2). pp. 363-367. ISSN 0001-6268, 0942-0940
Full text not available from this repository. (Request a copy)Abstract
Cerebral metastasis (CM) is the most common malignancy affecting the brain. In patients eligible for surgery, complete tumor removal is the most important predictor of overall survival and neurological outcome. The emergence of surgical microscopes fitted with a fluorescein-specific filter have facilitated fluorescein-guided microsurgery and identification of tumor tissue. In 2012, we started evaluating fluorescein (FL) with the dedicated microscope filter in cerebral metastases (CM). After describing the treatment results of our first 30 patients, we now retrospectively report on 95 patients. Ninety-five patients with CM of different primary cancers were included (47 women, 48 men, mean age, 60 years, range, 25-85 years); 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560-nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control. The extent of resection (EOR) was assessed by means of early postoperative contrast-enhanced MRI and the grade of fluorescent staining as described in the surgical reports. Furthermore, we evaluated information on neurological outcome and surgical complications as well as any adverse events. Ninety patients (95%) showed bright fluorescent staining that markedly enhanced tumor visibility. Five patients (5%); three with adenocarcinoma of the lung, one with melanoma of the skin, and one with renal cell carcinoma) showed insufficient FL staining. Thirteen patients (14%) showed residual tumor tissue on the postoperative MRI. Additionally, the MRI of three patients did not confirm complete resection beyond doubt. Thus, gross-total resection had been achieved in 83% (n = 79) of patients. No adverse events were registered during the postoperative course. FL and the YELLOW 560-nm filter are safe and feasible tools for increasing the EOR in patients with CM. Further prospective evaluation of the FL-guided technique in CM-surgery is in planning.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | SURGICAL MICROSCOPE FILTER; MULTIPLE BRAIN METASTASES; SINGLE METASTASES; RANDOMIZED-TRIAL; SURGERY; TUMORS; EXPERIENCE; RADIOTHERAPY; Fluorescein sodium; YELLOW 560-nm filter; Cerebral metastases; PENTERO 900; Surgical microscope; Fluorescence-guided surgery; Neurosurgery |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurochirurgie Medicine > Abteilung für Neuropathologie Medicine > Lehrstuhl für Röntgendiagnostik |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:01 |
| Last Modified: | 13 Feb 2019 14:10 |
| URI: | https://pred.uni-regensburg.de/id/eprint/508 |
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