| Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Acta Neurochirurgica | ||||
| Publisher: | SPRINGER WIEN | ||||
| Place of Publication: | WIEN | ||||
| Volume: | 159 | ||||
| Number of Issue or Book Chapter: | 2 | ||||
| Page Range: | pp. 363-367 | ||||
| Date: | 2017 | ||||
| Institutions: | Medicine > Lehrstuhl für Neurochirurgie Medicine > Abteilung für Neuropathologie Medicine > Lehrstuhl für Röntgendiagnostik | ||||
| Identification Number: |
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| 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 | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 38774 |
Web of ScienceAbstract
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 ...
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.
Metadata last modified: 06 May 2021 09:20
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