Fluorescence and image guided resection in high grade glioma

Panciani, Pier Paolo; Fontanella, Marco; Schatlo, Bawarjan; Garbossa, Diego; Agnoletti, Alessandro; Ducati, Alessandro; Lanotte, Michele

doi:10.1016/j.clineuro.2011.09.001

Cited by 88 publications

(73 citation statements)

References 22 publications

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“…Various authors have described that fluorescence-guided tumor resection increases the rate of complete excision of high-grade gliomas, without significantly increasing morbidity [4, 12, 16–22]. 5-ALA fluorescence allows for tumor “visualization” in real-time during surgery, including diffuse infiltration areas in which tumor cells are mixed with normal parenchyma, so the malignant tissue can be easily identified [23, 24] (Figures 2(a) and 2(b)).…”

Section: Discussionmentioning

confidence: 99%

Fluorescence-Guided Surgery and Biopsy in Gliomas with an Exoscope System

Piquer

Llácer

Rovira

et al. 2014

BioMed Research International

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Background. The introduction of fluorescence-guided resection allows a better identification of tumor tissue and its more radical resection. We describe our experience with a modified exoscope to detect 5 ALA-induced fluorescence in neuronavigation-guided brain surgery or biopsy of malignant brain tumors. Methods. Thirty-eight patients with a suspected preoperative diagnosis of high-grade astrocytoma were included. We used a neuronavigation device and a high-definition exoscope system with a built-in filter to detect 5-ALA fluorescence in all cases. Thirty patients underwent craniotomy with tumor resection and 8 underwent frameless stereotactic brain biopsy. Results. Histopathological diagnosis confirmed the presence of high-grade gliomas in 34 patients. Total resection was achieved in 23 cases and subtotal in 7. No relevant complications related to the administration of 5-ALA were detected. Conclusions. The use of the exoscope in 5-ALA fluorescence-guided tumor surgery has twofold implications: during brain tumor surgery it can be considered a valuable tool to achieve a more radical resection of the lesion, and when applied to a biopsy of a suspected brain high-grade glioma, it decreases the possibility of a negative biopsy.

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Section: Discussionmentioning

confidence: 99%

Fluorescence-Guided Surgery and Biopsy in Gliomas with an Exoscope System

Piquer

Llácer

Rovira

et al. 2014

BioMed Research International

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“…Oral administration of 5-ALA several hours before surgery and a modified neurosurgical microscope are required. In our experience, decisionmaking based on 5-ALA fluorescence positivity had a sensitivity of 91.1 % and a specificity of 89.4 % [47]. The impact of fluorescence in surgery for gliomas was clearly shown by a large, multicenter, phase III randomized controlled trial in which 5-ALA-guided resection resulted in a significantly higher resection rate that translated into a longer progression-free interval, as well as a longer median survival [37].…”

Section: Surgical Approach and Resection Strategiesmentioning

confidence: 93%

Resection of supratentorial gliomas: the need to merge microsurgical technical cornerstones with modern functional mapping concepts. An overview

2014

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Although surgery is not curative for the majority of intracranial gliomas, radical resection has been demonstrated to influence survival and delay tumor progression. Because gliomas are very frequently located in eloquent or more generally critical areas, surgeons must always balance the maximizing resection with the need to preserve neurological function. In this overview, we tried to summarize the recent literature and our personal experience about (1) the benefits and limits of using preoperative anatomical and functional neuroimaging (anatomical MRI, DTI fiber tracking, and functional MRI), (2) the issues to consider in planning the surgical strategy, (3) the need to thoroughly understand microsurgical techniques that enable a maximal resection (subpial dissection, vascular manipulation, etc.), (4) the importance of individualizing surgical strategy especially in patients with gliomas in eloquent areas (the role of neuropsychological evaluation in redefining eloquent and non-eloquent areas), and (5) how to use intraoperative mapping techniques and understand why and when to use them. Through this paper, the reader should become more familiar with a comprehensive panel of techniques and methodologies but more importantly become aware that these recent technical advances facilitate a conceptual change from classical surgical paradigms toward a more patient-specific approach.

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“…These phase III clinical trials have shown that the use of 5-ALA in surgery produces reliable results. This surgical method is more convenient for tumor resection and enables better resection of the tumor boundary, which improves survival rate [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Review of Neurosurgical Fluorescence Imaging Systems for Clinical Application

Kim

Lee

Yoo

et al. 2016

Journal of the Optical Society of Korea

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A number of fluorescence imaging techniques for use in the surgical removal of glioma have been developed over the course of the long history of neurosurgery. Various biomarkers, biochemical agents, and detection systems for glioma have also been developed. This review focuses on 5-aminolevulinic acid (5-ALA), which is used to detect glioma. Numerous forms of fluorescence-guided surgery use 5-ALA, which is helpful to the surgeon. The surgical microscope system is the observational method generally used with 5-ALA, while the loupe, endoscope, and exoscope are simpler alternatives. A system is needed for minimal resection and other issues that arise during neurosurgery. Such an enhanced system should be able to detect low-grade tumors and provide information on microinvasive diseases, resulting in an improved survival rate and better surgical skills. Development of systems that fulfill certain needs would help protect the brain function of the patient and broaden the use of such systems in neurosurgery.

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Fluorescence and image guided resection in high grade glioma

Cited by 88 publications

References 22 publications

Fluorescence-Guided Surgery and Biopsy in Gliomas with an Exoscope System

Fluorescence-Guided Surgery and Biopsy in Gliomas with an Exoscope System

Resection of supratentorial gliomas: the need to merge microsurgical technical cornerstones with modern functional mapping concepts. An overview

Review of Neurosurgical Fluorescence Imaging Systems for Clinical Application

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