gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Fluorescein sodium guided resection of recurrent glioblastoma multiforme

Meeting Abstract

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  • Julius Höhne - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Morgan Broggin - Department of Neurosurgery, IRCCS Foundation Neurological Institute "C. Besta", Milan, Italy
  • Markus J. Riemenschneider - Universitätsklinikum Regensburg, Abteilung für Neuropathologie, Regensburg, Deutschland
  • Paolo Ferroli - Department of Neurosurgery, IRCCS Foundation Neurological Institute "C. Besta", Milan, Italy
  • Alexander T. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
  • Francesco Acerbi - Department of Neurosurgery, IRCCS Foundation Neurological Institute "C. Besta", Milan, Italy, Italy
  • Karl-Michael Schebesch - Klinikum der Universität Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.03.03

doi: 10.3205/17dgnc193, urn:nbn:de:0183-17dgnc1931

Published: June 9, 2017

© 2017 Höhne et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Glioblastoma multiforme (GBM) is the most common primary brain tumor with a high recurrence rate. Maximizing the extent of resection (EOR) in recurrent GBM (rGBM) has proved to be the cornerstone of neurosurgical re-treatment. The emergence of surgical microscopes, fitted with fluorescein-specific filters have facilitated fluorescein-guided microsurgery and identification of tumor tissue. As shown before Fluorescein Sodium (FL) provides a high sensitivity and specificity for high grade glioma tissue. Here, we present our experience with FL and the dedicated surgical microscope filter YELLOW 560 nm in 81 patients with glioblastoma recurrence.

Methods: 81 patients with recurrent glioblastoma at different stages of the disease were included (41 women, 40 men, mean age 52 years). 5 mg/kg bodyweight of FL was intravenously injected approximately 45 min. before craniotomy. A YELLOW 560 nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control. Surgical reports were reviewed regarding the degree of fluorescent staining, postoperative MRIs within 48 hours regarding extent of resection and postoperative courses regarding neurological outcome, complications and any adverse events.

Results: Bright fluorescent staining was reported in all patients, which markedly enhanced tumor visibility and was deemed helpful for tumor resection. 14 patients (17 %) showed residual tumor tissue on postoperative MRI (n=9; 6 % near-total resection (NTR, >95 % volume), n=5; 6 % subtotal resection (STR, <90 % volume). Thus, gross-total resection (GTR, residual enhancement <0.175 cm3) was achieved in 67 (83 %) of patients. No adverse events were registered during.

Conclusion: FL and YE560 is a readily available method for fluorescence-guided tumor resection similar to contrast enhancement in T1-weighted MRI. FL may improve resection with minimal risk, and tumor margins are clearly visualized. FL and the YELLOW 560 nm filter are safe and feasible tools for safe maximal resection of recurrent disease in glioblastoma.