gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Fluorescence-guided surgery for glioblastoma multiforme: Analysis of the extent of tumor resection during the past 11 years

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  • corresponding author T. Kuroiwa - Department of Neurosurgery, Osaka Medical College
  • Y. Kajimoto - Department of Neurosurgery, Osaka Medical College
  • M. Miyashita - Department of Neurosurgery, Osaka Medical College
  • H. Tanaka - Department of Neurosurgery, Osaka Medical College
  • S.I. Miyatake - Department of Neurosurgery, Osaka Medical College

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.07.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc042.shtml

Published: May 8, 2006

© 2006 Kuroiwa 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

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Objective: The prognosis of patients with glioblastoma multiforme (GBM) is thought to be improved by total resection of the enhanced area on CT or MRI. The key point GBM surgery is to remove as much of the main mass as possible without any additional neurological deficits. Following recent advances in fluorescence-guided techniques during surgery, total resection of even poorly demarcated tumors is now relatively easy if it is performed with a fluorescent operative microscope. During the past 11-year period, we conducted tumor resection under fluorescence guide, using fluorescein sodium (FLS; the first-generation fluorescence guide) or 5-aminolevulinic acid (ALA (Stummer, 2000); the second-generation fluorescence guide). This presentation will report our recent review of the effect of using a fluorescence guide in improving the extent of surgical resection of malignant gliomas.

Methods: This study involved all 79 patients with GBM who underwent surgery after 1990. We analyzed three periods, i.e., the period during which no fluorescence guide was applied, between 1990 and 1994 (the non-applied period; 17 cases), the period during which the FLS fluorescence guide was applied, between 1995 and 2002 (the FLS period; 36 cases) and the period during which the ALA fluorescence guide was applied, after 2003 (the ALA period; 26 cases). The extent of tumor resection was calculated as the percentage of tumor size reduction on the day after surgery compared with the pre-operative size as determined by volumetry on Gd-enhanced magnetic resonance images.

Results: The FLS-positive area coincided with the enhanced area on CT or MRI. In cases with ALA, it was positive about 80%. The percentage of cases where 95% or more tumor resection was possible was only 6% during the non-applied period. During the FLS period, this was possible in 28% of all cases, and it was possible in 53% of all cases during the ALA period. The prognosis of these cases with 95% or more tumor resection improved significantly.

Conclusions: Fluorescence-guided surgery markedly improved the extent of tumor resection and prognosis in patients with GBM. The improvement was particularly marked when ALA was used as the guide.