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首页> 外文期刊>Acta Neurochirurgica >Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery - A feasibility study
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Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery - A feasibility study

机译：YELLOW 560 nm手术显微镜滤镜下荧光素钠引导下切除术在恶性脑肿瘤手术中的可行性研究

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Objective: In glioma surgery, the extent of resection (EOR) is one important predictor of progression-free survival. In 2006, fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) was shown to improve the EOR in malignant gliomas. However, the use of 5-ALA is complex and causes certain side effects. Sodium fluorescein (FL) is a fluorescent dye that is used for angiography in ophthalmic surgery. FL accumulates in areas of the disturbed blood-brain barrier and can be visualized under a 560-nm wavelength fluorescent light source (YELLOW 560 nm, Carl Zeiss Meditec, Oberkochen, Germany). Here, we present the first experiences with low-dose FL and YELLOW 560 nm in 35 patients with malignant brain tumors. Patients and method: A total of 200 mg of FL (3-4 mg/kg bodyweight) was administered in 35 patients during craniotomy as an off-label use between May and August 2012. We retrospectively analyzed the histology, pre-treatment, clinical parameters pre- and postoperatively and occurrence of any adverse effects. The feasibility and efficacy ('helpful,' 'not helpful') of FL under YELLOW 560 nm (demarcation of the tumor margin) was assessed by the responsible neurosurgeon (n = 5) for each surgical procedure. Results: Twenty-six patients had gliomas (1 WHO grade I, 3 WHO grade II, 5 WHO grade III, 17 WHO grade IV), 5 patients had cerebral metastases, 2 had non-malignant astrogliosis and 2 had post-radiation necrosis. The fluorescence signal was detected in all patients immediately after the FL administration. FL application was classified as 'helpful' in 28 patients, implying improved visualization of the tumor margins. The intensity of the fluorescence signal seemed to be correlated to the histology and was strongly dependent on the pre-treatment status. We did not record any allergic reactions or any other adverse effects. Conclusion: The use of FL for the resection of brain tumors is safe and feasible. Presumably, the visualization of the tumor margin depends on the histopathology and on the pre-treatment status. A randomized evaluation of FL under the YELLOW 560 nm filter is planned to prospectively analyze the extent of resection in patients with malignant brain tumors.
机译：目的：在神经胶质瘤手术中，切除范围（EOR）是无进展生存的重要预测指标。在2006年，使用5-氨基乙酰丙酸（5-ALA）的荧光引导手术显示可改善恶性神经胶质瘤的EOR。但是，使用5-ALA很复杂，并且会引起某些副作用。荧光素钠（FL）是一种荧光染料，用于眼科手术中的血管造影。 FL聚集在受干扰的血脑屏障区域，并且可以在波长为560 nm的荧光光源（黄色560 nm，卡尔·蔡司Meditec，Oberkochen，德国）下观察。在这里，我们介绍了35例恶性脑肿瘤患者的小剂量FL和黄560 nm的首次使用经验。患者和方法：2012年5月至2012年8月间，在开颅手术期间共对35例患者进行了200 mg的FL（3-4 mg / kg体重）的配伍使用。我们回顾性分析了组织学，治疗前，临床术前和术后的参数以及任何不良反应的发生。在每种手术过程中，由负责的神经外科医生（n = 5）评估在黄色560 nm（肿瘤边缘分界）下FL的可行性和疗效（“有用”，“无用”）。结果：26例脑胶质瘤（1例WHO I级，3例WHO II级，5例WHO III级，17例WHO IV级），5例发生脑转移，2例非恶性星形胶质增生和2例放射后坏死。服用FL后立即在所有患者中检测到荧光信号。 FL应用在28例患者中被列为“有帮助”，这意味着肿瘤切缘的可视化得到了改善。荧光信号的强度似乎与组织学相关，并且强烈依赖于治疗前的状态。我们没有记录任何过敏反应或任何其他不良反应。结论：FL用于脑肿瘤切除术是安全可行的。据推测，肿瘤边缘的可视化取决于组织病理学和治疗前状态。计划在YELLOW 560 nm滤光片下进行FL的随机评估，以前瞻性分析恶性脑肿瘤患者的切除范围。

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