Artikel
Fluorescence-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery – A feasibility study
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Autoren
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Karl-Michael Schebesch
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Martin Proescholdt
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Julius Höhne
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Christoph Hohenberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Ernil Hansen
- Klinik für Anesthesiologie, Universitätsklinikum Regensburg
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Markus J. Riemenschneider
- Abteilung für Neuropathologie, Universitätsklinikum Regensburg
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Winfried Ullrich
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Christian Doenitz
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Juergen Schlaier
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Max Lange
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
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Alexander Brawanski
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: In glioma surgery, the extent of resection (EOR) is one important predictor of the progression-free survival. In 2006, fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has been shown to improve the EOR in malignant gliomas. However, the use of 5-ALA is complex and has certain side effects. Fluorescein Sodium (FS) is a fluorescent dye that is used for angiography in ophthalmic surgery. FL accumulates in areas of a 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 our first experiences with low-dose FS and YELLOW 560 nm in 35 patients with malignant brain tumors.
Method: 200 mg of FS (3–4 mg/kg bodyweight) were administered in 35 patients during craniotomy as an off-label use between May and August 2012. We retrospectively analyzed the histopathologies, the pre-treatment modalities, the clinical condition pre- and postoperatively and the occurrence of any adverse or side effects. The feasibility and efficacy (´helpful´, ´not helpful´) of FL under YELLOW 560 nm (demarcation of the tumor margin) was assessed by the responsible neurosurgeons (n=5) of each surgical procedure.
Results: 26 patients had gliomas (1 WHO I, 3 WHO II, 5 WHO III, 17 WHO IV), 5 patients had cerebral metastases, 2 patients had non-malignant astrogliosis and 2 patients had post-radiation necrosis. The fluorescence was detected in all patients immediately after the administration. FS 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 histopathology and was dependent on the pre-treatment status. We did not record any allergic reactions or any other adverse effects.
Conclusions: The use of FS 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 FS under the YELLOW 560 nm filter is planned to prospectively analyze the extent of resection in patients with malignant brain tumors.
