ATPS-56SODIUM FLUORESCEIN-GUIDED SURGERY UNDER THE YELLOW 560 NM SURGICAL MICROSCOPE FILTER IN 14 GLIOMA PATIENTS

Objective. Sodium fluorescein (FL) had been safely used in fluorescence-guided microsurgery for imaging various brain tumors. Under the YELLOW 560 nm surgical microscope filter, low-dose FL as a fluorescent dye helps in visualization. Our study investigated the safety and efficacy of this innovative technique in malignant glioma (MG) patients. Patients and Method. 38 patients suffering from MGs confirmed by pathology underwent FL-guided resection under YELLOW 560 nm surgical microscope filter. We retrospectively analyzed the clinical characters, microsurgery procedure, extent of resection, pathology of MGs, progression-free survival (PFS), and overall survival (OS). Results. Thirty-eight patients had MGs (10 WHO grade III, 28 WHO grade IV). With YELLOW 560 nm surgical microscope filter combined with neuronavigation, sodium fluorescein-guided gross total resection (GTR) was achieved in 35 (92.1%) patients and subtotal resection in 3 (7.69%). The sensitivity and specificity of FL were 94.4% and 88.6% regardless of radiographic localization. Intraoperatively, 10 biopsies (10/28 FL[+]) showed “low” or “high” fluorescence in non-contrast-enhancement region and are also confirmed by pathology. Our data showed 6-month PFS of 92.3% and median survival of 11 months. Conclusion. FL-guided resection of MGs under the YELLOW 560 nm surgical microscope filter combined with neuronavigation was safe and effective, especially in non-contrast-MRI regions. It is feasible for improving the extent of resection in MGs especially during emergency cases.

Download Full-text

Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases

Acta Neurochirurgica ◽

10.1007/s00701-013-1734-9 ◽

2013 ◽

Vol 155 (7) ◽

pp. 1277-1286 ◽

Cited By ~ 83

Author(s):

Francesco Acerbi ◽

Morgan Broggi ◽

Marica Eoli ◽

Elena Anghileri ◽

Lucia Cuppini ◽

...

Keyword(s):

Preliminary Results ◽

Guided Surgery ◽

Surgical Microscope

Download Full-text

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

Download Full-text

Hybrid fluorescein-guided surgery for pituitary adenoma resection: a pilot study

Journal of Neurosurgery ◽

10.3171/2019.1.jns181512 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1490-1498 ◽

Cited By ~ 1

Author(s):

Samuel Romano-Feinholz ◽

Víctor Alcocer-Barradas ◽

Alejandra Benítez-Gasca ◽

Ernesto Martínez-de la Maza ◽

Cristopher Valencia-Ramos ◽

...

Keyword(s):

Pituitary Adenoma ◽

Pilot Study ◽

Pituitary Adenomas ◽

Tumor Resection ◽

Scar Tissue ◽

Spectrophotometric Analysis ◽

Guided Surgery ◽

Yellow 560 ◽

Acth Secreting ◽

Microscopic Techniques

OBJECTIVEThe authors conducted a pilot study on hybrid fluorescein-guided surgery for pituitary adenoma resection and herein describe the feasibility and safety of this technique.METHODSIn this pilot study, the authors included all consecutive patients presenting with pituitary adenomas, functioning and nonfunctioning. They performed a hybrid fluorescein-guided surgical technique for tumor resection. An endonasal endoscopic approach was used; after exposure of the rostrum of the sphenoid sinus, they administered a bolus of 8 mg/kg of fluorescein sodium (FNa) intravenously, and during resection, they alternated between endoscopic and microscopic techniques to guide the resection under a YELLOW 560 filter.RESULTSThe study included 15 patients, 7 men (47%) and 8 women (53%). Of the pituitary adenomas, 7 (46%) were nonfunctioning, 6 (40%) were GH secreting, 1 (7%) was prolactin secreting, and 1 (7%) was ACTH secreting. There were no FNa-related complications (anaphylactic reactions); yellowish staining of urine, skin, and mucosa was seen in all patients and resolved in a maximum time of 24 hours. After color spectrophotometric analysis, the authors identified a statistical difference in fluorescence among tumor, gland, and scar tissue (p = 0.01).CONCLUSIONSThis is the first study of its kind to describe the feasibility and safety of using FNa to guide the resection of pituitary adenomas. The authors found this technique to be safe and feasible. It may be used to obtain better surgical results, especially for hormone-producing and recurring tumors, as well as for reducing the learning curve in pituitary adenoma surgery.

Download Full-text

The use of fluorescein sodium in the biopsy and gross-total resection of a tectal plate glioma

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.5.peds15142 ◽

2015 ◽

Vol 16 (6) ◽

pp. 732-735 ◽

Cited By ~ 4

Author(s):

Timothy H. Ung ◽

Christopher Kellner ◽

Justin A. Neira ◽

Shih-Hsiu J. Wang ◽

Randy D’Amico ◽

...

Keyword(s):

Intravenous Administration ◽

Pilocytic Astrocytoma ◽

Complete Resection ◽

Fluorescein Sodium ◽

Tissue Sampling ◽

Total Resection ◽

Surgical Microscope ◽

Tectal Plate ◽

Yellow 560 ◽

Intraoperative Guidance

Intravenous administration of fluorescein sodium fluoresces glioma burden tissue and can be visualized using the surgical microscope with a specialized filter. Intraoperative guidance afforded through the use of fluorescein may enhance the fidelity of tissue sampling, and increase the ability to accomplish complete resection of tectal lesions. In this report the authors present the case of a 19-year-old man with a tectal anaplastic pilocytic astrocytoma in which the use of fluorescein sodium and a Zeiss Pentero surgical microscope equipped with a yellow 560 filter enabled safe complete resection. In conjunction with neurosurgical navigation, added intraoperative guidance provided by fluorescein may be beneficial in the resection of brainstem gliomas.

Download Full-text

NIMG-12. MULTICOLOURED-ASSISTED SURGERY FOR RESECTION OF HIGH GRADE GLIOMAS WITH 5-AMINOLEVULINACID

Neuro-Oncology ◽

10.1093/neuonc/noz175.684 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi164-vi164

Author(s):

Cleopatra Charalampaki ◽

Dimitrios Atanasopoulos

Keyword(s):

Real Time ◽

White Light ◽

High Grade ◽

Field Orientation ◽

Additional Information ◽

Guided Surgery ◽

Surgical Microscope ◽

Fluorescence Guided Surgery ◽

Surgical Field ◽

High Grade Gliomas

Abstract INTRODUCTION Fluorescence guided surgery with the use of 5-aminolevulinacid (5 -ALA) is nowadays the state of the art treatment of high grade gliomas. However, intraoperative visualization of 5-ALA under dark blue light remains challenging, especially when leaking blood covers parts of the surgical field, where tumor fluorescence becomes invisible. To overcome this problem and combine the brightness of visible light with the information delivered by fluorescence we developed multispectral fluorescence, a technique able to project both information in real time to the surgeon’s eyes, and embedded it on a surgical microscope. METHODS We examined 40 patients with brain tumors who underwent surgery, using the MFL operative technique. The tumors involved comprised of 20 glioblastomas, 7 astrocytomas WHO III, 5 meningiomas and 8 metastatic tumors. The MFL technique with the real-time overlay of 5-ALA fluorescence and white light was intraoperatively compared to the classic blue filter detecting 5-ALA fluorescence. RESULTS The tumor was in all cases clearly visible and highlighted from the surrounding tissues. The pseudocolor we chose to visualize the tumor was green, representing 5-ALA fluorescence, with the surrounding brain tissueremained in its origin white color. In the cases where blood was covering the surgical field, orientation was easy to maintain, due to the additional information delivered from the white light image. CONCLUSIONS The MFL technique embedded on a surgical microscope opens the way for a precise and clear visualization of tumor 5-ALA fluorescence in real time under white light. It can be easily implemented in the resection of all tumors accumulating 5-ALA. Drawbacks of classic 5-ALA fluorescence such as hidden fluorescence because of overlying blood could be overcome with the presence of additional white light and the clear visualization of the exposed brain.

Download Full-text