gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Evaluation of malignant glioma resection in fluorescence guided surgery

Meeting Abstract

  • I.Y. Eyupoglu - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • N. Hore - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • N.E. Savaskan - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • P. Grummich - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • M. Buchfelder - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • O. Ganslandt - Neurochirurgische Klinik, Universitätsklinikum Erlangen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.09.04

DOI: 10.3205/12dgnc082, URN: urn:nbn:de:0183-12dgnc0827

Published: June 4, 2012

© 2012 Eyupoglu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Despite continuing debates on cytoreductive surgery there is consensus that the extent of reduction in tumor volume improves overall survival in malignant gliomas and is beneficial for adjunctive therapies. Since complete resection of gliomas in the vicinity of functionally eloquent brain areas is extremely difficult, extensive attempts have been made to visualize tumor extensions intraoperatively. The two well-studied and established methods for visualization of tumors, 5-ALA as a biochemical marker, and intraoperative MRI (iMRI) as morphological means, were previously facilitated independently. Both methods significantly increase the rate of success in gross total tumor resection in comparison to classical approaches.

Methods: Herein, in 20 cases of patients with malignant gliomas we combined both techniques using 5-ALA in the first line and evaluated our result thereafter by iMRI to evaluate the magnitude and outcome of resections.

Results: Using this approach we identified that resection of gliomas in non-eloquent brain areas 5-ALA as a tool is sufficient to achieve a complete removal. In grade III tumors (functional location grade according to Sawaya – tumor is located in an eloquent brain area) either the results could be unsatisfactory resections or neurological deficits if an iMRI with integrated functional neuronavigation was not included. However, the goal of this study was to identify the subgroup of grade II tumors (tumor is located close to an eloquent brain area) which could profit from the combination of both techniques: We increased significantly the extent of tumor resection from 68.6% to 100% (p = 0.013, t-test).

Conclusions: We found that 5-ALA clearly delineates tumor borders in the operation field in real time, improving first line tumor resection. However, depending on the angle of view and anatomical localization, fluorescence guided surgery may leaves residual and potentially removable tumor undetected, thus hindering gross total resection in functional grade II tumors. IMRI reveals total tumor expansion during surgery and opens the possibility for extended resection of residual or undiscovered tumor tissue within the same operative session. Therefore, fluorescence guided visualization is compatible with iMRI, assisting in improved visualization of tumor borders and achieving more precise and frequent complete resection of tumors. Thus, this combined technical approach makes it especially appropriate for glioblastoma surgery close to eloquent brain areas.