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Lighting Up the Tumor—Fluorescein-Guided Resection of Gangliogliomas
Höhne, Julius, Acerbi, Francesco, Falco, Jacopo, Akçakaya, Mehmet Osman, Schmidt, Nils Ole
, Kiris, Talat, de Laurentis, Camilla, Ferroli, Paolo, Broggi, Morgan
and Schebesch, Karl-Michael
(2020)
Lighting Up the Tumor—Fluorescein-Guided Resection of Gangliogliomas.
Journal of Clinical Medicine 9 (8), p. 2405.
Date of publication of this fulltext: 12 Nov 2020 13:33
Article
DOI to cite this document: 10.5283/epub.44155
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 ...
(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.
Involved Institutions
Details
| Item type | Article | ||||
| Journal or Publication Title | Journal of Clinical Medicine | ||||
| Publisher: | MDPI | ||||
|---|---|---|---|---|---|
| Place of Publication: | BASEL | ||||
| Volume: | 9 | ||||
| Number of Issue or Book Chapter: | 8 | ||||
| Page Range: | p. 2405 | ||||
| Date | 28 July 2020 | ||||
| Institutions | Medicine > Lehrstuhl für Neurochirurgie | ||||
| Identification Number |
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| 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 | ||||
| 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 | ||||
| URN of the UB Regensburg | urn:nbn:de:bvb:355-epub-441556 | ||||
| Item ID | 44155 |
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