The Usefulness of Stereotactic Neuronavigation Along with Intraoperative Imaging in Malignant Brain Tumor Surgery

Abstract Although maximal safe resection is the current standard for glioblastoma surgery, its safety and removal rate conflict with each other. Electrophysiological monitoring, such as motor evoked potential monitoring and awake craniotomy, can be utilized as safety measures; not all facilities can perform them. Herein, we present a representative case report on our efforts for a safe malignant brain tumor surgery. Case: A 77-year-old woman with glioblastoma in the premotor cortex presented with seizure of the upper left lower limb. Her pyramidal tract ran from the medial bottom to the posterior of the tumor. We performed excision from the site using the lowest gamma entropy. We then removed all parts of the tumor, with the exception of the pyramidal tract infiltration, and no paralysis was observed. She was definitively diagnosed with glioblastoma and is currently on maintenance chemotherapy. As a preoperative examination, we performed cerebrovascular angiography. We then performed various other tests to ascertain the patient’s condition. Considering lesions that affect language, Wada tests were performed regardless of laterality. For all patients with epilepsy onset, preoperative 256-channel electroencephalogram measurement and intraoperative the gamma entropy analysis were performed to confirm epileptogenicity. Considering lesions that affect eloquence, subdural electrodes were placed and brain function mapping was performed the next day. Based on the results, the safest cortical incision site and excision range were determined, and excision was performed on the following day. Of the 14 operated glioblastoma cases after November 2018, more than 85% of the contrast-enhanced lesions were completely removed in 7 cases, partially removed in 5 cases, and underwent biopsy in 2 cases. Postoperative Karnofsky performance status scores remained unchanged in 11 cases, improved in 1 case, and deteriorated in 2 cases. Our efforts have resulted in safe and sufficient removal of malignant brain tumors during surgery.

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Answer to: “Sodium fluorescein-guided resection under the YELLOW 560-nm surgical microscope filter in malignant brain tumor surgery—a feasibility study” (April 2013, Volume 155, Issue 4, pp 693–69)

Acta Neurochirurgica ◽

10.1007/s00701-013-1752-7 ◽

2013 ◽

Vol 155 (7) ◽

pp. 1319-1320 ◽

Cited By ~ 9

Author(s):

Ricardo Diez Valle ◽

Sonia Tejada Solis

Keyword(s):

Brain Tumor ◽

Feasibility Study ◽

Malignant Brain Tumor ◽

Sodium Fluorescein ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Surgical Microscope ◽

Yellow 560

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Sodium fluorescein–guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery—a feasibility study

Acta Neurochirurgica ◽

10.1007/s00701-013-1643-y ◽

2013 ◽

Vol 155 (4) ◽

pp. 693-699 ◽

Cited By ~ 104

Author(s):

Karl-Michael Schebesch ◽

Martin Proescholdt ◽

Julius Höhne ◽

Christoph Hohenberger ◽

Ernil Hansen ◽

...

Keyword(s):

Brain Tumor ◽

Feasibility Study ◽

Malignant Brain Tumor ◽

Sodium Fluorescein ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Surgical Microscope ◽

Yellow 560

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Surgical complications following malignant brain tumor surgery: An analysis of 2002–2011 data

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2015.11.005 ◽

2016 ◽

Vol 140 ◽

pp. 6-10 ◽

Cited By ~ 31

Author(s):

Rafael De la Garza-Ramos ◽

Panagiotis Kerezoudis ◽

Rafael J. Tamargo ◽

Henry Brem ◽

Judy Huang ◽

...

Keyword(s):

Brain Tumor ◽

Surgical Complications ◽

Malignant Brain Tumor ◽

Tumor Surgery ◽

Brain Tumor Surgery

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COT-13 Luminance analysis of 5-aminolevulinic acid using Image J for malignant brain tumor

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab159.117 ◽

2021 ◽

Vol 3 (Supplement_6) ◽

pp. vi30-vi30

Author(s):

Takashi Kon ◽

Yusuke Kobayashi ◽

Yosuke Sato ◽

Katsuyoshi Shimizu ◽

Tohru Mizutani

Keyword(s):

Brain Tumor ◽

Malignant Glioma ◽

Aminolevulinic Acid ◽

Malignant Gliomas ◽

Malignant Brain Tumor ◽

Photodynamic Diagnosis ◽

Tumor Surgery ◽

Maximum Luminance ◽

Brain Tumor Surgery ◽

Average Maximum

Abstract Purpose: For malignant brain tumor surgery, photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) is useful for maximal removal of the tumor. Although it has the advantage of identifying the presence or absence of residual tumors during surgery, there are variations in positive rates, and the classification is limited, based on visual inspection such as Stummer’s classification (strong, vague, none). We analyzed the luminance of positive findings using software Image J for brain tumor surgery using 5-ALA, and we report the results. Materials and Methods: From April 2018 to March 2021, 31 patients with suspected malignant glioma before surgery were included. Intraoperative 5-ALA positive findings were analyzed by software Image J (Wayne Rasband: NIH), the luminance was measured with a histogram, and compared the maximum luminance titer. Results: Among the positive cases, the average maximum luminance value for malignant glioma was 101 (50–168), which consisted of 11 cases of Glioblastoma, 1 case of Oligodendroglioma, and 1 case of anaplastic astrocytoma. The average maximum brightness of metastatic brain tumors is lower than that of malignant gliomas, even if they are visually strong, 83.5 (28–121). Conclusions: Even if it is visually strong in the conventional Stummer classification, it may be possible to classify in detail by analyzing luminance with Image J. In addition, more objective index is necessary to classify the vague findings.

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