Application of Intraoperative Indocyanine Green Angiography for CNS Tumors: Results on the First 100 Cases

Ferroli, Paolo; Acerbi, Francesco; Albanese, Erminia; Tringali, Giovanni; Broggi, Morgan; Franzini, Andrea; Broggi, Giovanni

doi:10.1007/978-3-211-99651-5_40

Cited by 87 publications

(41 citation statements)

References 21 publications

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“…It is also important to recognize that, even with fluorescein-guided technique and under specific filter visualization, a complete removal of favorable HGGs is not always possible. As for other types of fluorescence tools (8,42,43), it is possible to visualize the pathologic tissue only if it is properly exposed during the surgical approach; thus, some residual may be left behind, especially when small corticectomy has been performed and the fluorescent tissue is in the blind corner of HGG growth relies on the formation of new blood vessels that are characterized by increased permeability, with a consequent damage in the BBB (44)(45)(46). Fluorescein accumulation in the extracellular space of HGG tissue is related to the passage through this damaged BBB, due to the presence of high-density tumor cells (16).…”

Section: Discussionmentioning

confidence: 99%

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Acerbi

Broggi

Schebesch

et al. 2018

Clinical Cancer Research

164

142

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Purpose: Sodium fluorescein is a dye that, intravenously injected, selectively accumulates in high-grade glioma (HGG) tissue through a damaged blood-brain barrier. In this article, the final results of a multicentric prospective phase II trial (FLUO-GLIO) on fluorescein-guided HGG resection through a dedicated filter on the surgical microscope were reported.Methods: Patients with suspected HGGs considered suitable for removal were eligible to participate in this trial. Fluorescein was intravenously injected at a dose of 5 to 10 mg/kg. The primary endpoint was the percentage of patients with histologically confirmed HGGs, without contrast-enhancing tumor at the immediate postoperative MRI. Secondary endpoints were PFS, residual tumor on postoperative MRI, overall survival, neurologic deficits, and fluorescein-related toxicity. The sensitivity and specificity of fluorescein in identifying tumor tissue were estimated by fluorescent and nonfluorescent biopsies at the tumor margin. The study was registered on the European Regulatory Authorities website (EudraCT 2011-002527-18).Results: Fifty-seven patients aged 45 to 75 years were screened for participation, and 46 were considered for primary and secondary endpoints. Mean preoperative tumor volume was 28.75 cm 3 (range, 1.3-87.8 cm 3 ). Thirty-eight patients (82.6%) underwent a complete tumor removal. Median follow-up was 11 months. PFS-6 and PFS-12 were 56.6% and 15.2%. Median survival was 12 months. No adverse reaction related to SF administration was recorded. The sensitivity and specificity of fluorescein in identifying tumor tissue were respectively 80.8% and 79.1%.Conclusions: Fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and enables a high percentage of contrast-enhancing tumor in patients with HGGs.

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Section: Discussionmentioning

confidence: 99%

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Acerbi

Broggi

Schebesch

et al. 2018

Clinical Cancer Research

164

142

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“…Do they think that bridging veins with flow inversion can be safely sacrificed? In our experience, this was not found to be true, since we observed that a relief of mass effect after tumor debulking can re-establish flow in an anterograde direction and possibly contribute to reducing peritumoral edema due to venous congestion [2]. Thus, the direction of venous flow before the removal of the meningioma cannot be considered the key point.…”

mentioning

confidence: 83%

The role of indocyanine green videoangiography (ICGV) in surgery of parasagittal meningiomas

et al. 2013

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“…Neovascular architecture; alterations of the caliber, morphology, and course of vessels; and the hemodynamic patterns can be observed. The dye does not penetrate the membrane and therefore is unable to define the margins of the tumors (42). ICG helps to avoid injury by preserving small caliber vessels during brain tumor surgery (Figure 3).…”

Section: Indocyanine Greenmentioning

confidence: 99%

Surgical Management of Glioblastoma

2017

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Malignant gliomas are characterized by their propensity to invade surrounding brain parenchyma. The median survival of patients is less than 2 years with maximal surgical resection, chemotherapy, and radiotherapy. Although there have been controversial arguments about the role of surgical resection, there is increasing evidence that a safe and radical removal of malignant glioma is associated with a better survival outcome. Surgery is still essential to obtain brain tissue for pathological analysis, and reduce mass effect. Intraoperative magnetic resonance imaging, neuronavigation, ultrasonography, and fluorescence-guided surgery are the most used tools worldwide. 5-Aminolevulinic acid surgery, combined with Stupp protocol, produces a median survival of 15 months. The objectives of perioperative positioning are to enhance optimal exposure, prevent injury related to position, and maintain normal body alignment without excess flexion, extension, or rotation. Advances in surgical techniques have contributed to enhanced recovery after tumor resection, improved postoperative functional status, and decreased length of stay in the hospital. This chapter presents the current literature related to the surgical management of high-grade gliomas.

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Application of Intraoperative Indocyanine Green Angiography for CNS Tumors: Results on the First 100 Cases

Cited by 87 publications

References 21 publications

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

The role of indocyanine green videoangiography (ICGV) in surgery of parasagittal meningiomas

Surgical Management of Glioblastoma

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