Fluorescence-Guided Surgery for High-Grade Gliomas: State of the Art and New Perspectives

Palmieri, Giuseppe; Cofano, Fabio; Salvati, Luca Francesco; Monticelli, Matteo; Zeppa, Pietro; Perna, Giuseppe Di; Melcarne, Antonio; Altieri, Roberto; Rocca, Giuseppe La; Sabatino, Giovanni; Barbagallo, Giuseppe; Tartara, Fulvio; Zenga, Francesco; Garbossa, Diego

doi:10.1177/15330338211021605

Cited by 26 publications

(21 citation statements)

References 98 publications

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“…While recognizing the limits of the method, which is a probable in vivo representation of white matter tracts, the relevant role of the same is recognized in helping neurosurgeon in the difficult task of maximizing the extent of resection preserving neurocognitive outcome. This method is not in contrast to other techniques to increase the accuracy of resection but implements the possibilities of the much sought-after maximal safe resection alongside the use of direct stimulation to awake patients and fluorescence guided surgery [ 25 , 26 ]. To increase the extent of resection it is possible to combine the use of 5-ALA fluorescence with contrast-enhanced ultrasound [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Relevant Role of Navigated Tractography in Speech Eloquent Area Glioma Surgery: Single Center Experience

et al. 2021

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Background: Gliomas are among the most challenging pathologies for neurosurgeons due to their infiltrative and recurrent nature in functionally relevant regions. Current knowledge confirms that gross total resection highly influence survival in patient with glioma. However, surgery performed in eloquent brain area, could seriously compromise the quality of life in patient with reduced life expectancy even more if it concerns the language function. Methods: 18 right-handed patients with perisylvian gliomas on the left hemisphere were prospectively analyzed over a period of 12 months. Standardized preoperative Diffusion-Tensor-Imaging based tractography of the five main language Tracts (Arcuate Fasciculus, Frontal Aslant Tract, Inferior Fronto-Occipital Fasciculus, Inferior Longitudinal Fasciculus, Uncinate Fasciculus) was navigated during the surgical procedure. Using a validated method, correlations were made between the pre-operative fascicles and their possible infiltration and surgical damage. The language status was assessed using the Aachen Aphasia Test. Results: In all nine patients who developed a permanent disorder there was pre-operative involvement of at least one fascicle and resection of at least one of these. In this way, areas of high risk of permanent language damage have emerged as a result of surgical injury: the temporoparietal junction, the middle portion of the FAT and the temporal stem. Conclusions: Navigated tractography has proven to be a user-friendly tool that can assess perioperative risk, guide surgical resection, and help the neurosurgeon to find that balance between tumor resection and function preservation.

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Section: Discussionmentioning

confidence: 99%

The Relevant Role of Navigated Tractography in Speech Eloquent Area Glioma Surgery: Single Center Experience

et al. 2021

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“…As a result, the separation of the tumor and healthy tissue, and the collection of samples prove challenging and remain limited by the anatomy and neurological function of the brain. To overcome this issue in the clinic, fluorescent-guided surgeries were performed to achieve the gross resection of tumors [ 166 ]. Moreover, by using Raman scattering histology, the intraoperative detection of residual tumor cells is now possible in a rapid and label-free manner [ 167 ].…”

Section: Unbiased High-throughput Experimental Approaches To Study Glioblastoma Invasionmentioning

confidence: 99%

Tumor Cell Infiltration into the Brain in Glioblastoma: From Mechanisms to Clinical Perspectives

Seker-Polat

Degirmenci

Solaroğlu

et al. 2022

Cancers

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Glioblastoma is the most common and malignant primary brain tumor, defined by its highly aggressive nature. Despite the advances in diagnostic and surgical techniques, and the development of novel therapies in the last decade, the prognosis for glioblastoma is still extremely poor. One major factor for the failure of existing therapeutic approaches is the highly invasive nature of glioblastomas. The extreme infiltrating capacity of tumor cells into the brain parenchyma makes complete surgical removal difficult; glioblastomas almost inevitably recur in a more therapy-resistant state, sometimes at distant sites in the brain. Therefore, there are major efforts to understand the molecular mechanisms underpinning glioblastoma invasion; however, there is no approved therapy directed against the invasive phenotype as of now. Here, we review the major molecular mechanisms of glioblastoma cell invasion, including the routes followed by glioblastoma cells, the interaction of tumor cells within the brain environment and the extracellular matrix components, and the roles of tumor cell adhesion and extracellular matrix remodeling. We also include a perspective of high-throughput approaches utilized to discover novel players for invasion and clinical targeting of invasive glioblastoma cells.

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“…In addition to commonly used white light microscopes, newer devices include neuronavigation, electrophysiological cerebral mapping, and intraoperative magnetic resonance imaging (iMRI) systems. Some of the recent advances involve intraoperative implementation of fluorescent markers that may also be a significant support for the neuro-oncological surgeon [2], [10].…”

Section: Background mentioning

confidence: 99%

Evaluation of the effect of fluorescein sodium-guided under yellow 560nm surgical microscope filter in surgery for high grade gliomas: Preliminary results in a series of 27 patients

Yen

Dung

2021

YDLS

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Objective: The importance of a complete resection of high‑grade gliomas (HGGs) has been highlighted in scientific literature, in order to limit tumor recurrence and above all to improve disease‑free survival rates. Several fluorescent biomarkers have been tested to improve intraoperative identification of residual tumor. The fluorescein sodium (FS) are now starting to play an important role in glioma surgery. Under the YELLOW 560nm surgical microscope filter, low-dose FS (5mg/kg) as a ﬂuorescent dye helps in visualization of tumor tissue. Our study provides preliminary results in investigating the safety and efficacy of this technique in patients with HGGs. Subject and method: A prospective, uncontrolled study of 27 patients with HGGs underwent FS-guided resection under YELLOW 560nm surgical microscope filter. We have analyzed the clinical features, size, tumor location, extent of tumor resection, pathologic of HGGs, patient status (Karnofsky Performance Scale) and FS side effects. Result: 7/27 patients (25.9%) were glioma grade III and 20/27 patients (74.1%) were glioma multiforme (GBM). With YELLOW 560nm surgical microscope filter (PENTERO 900 surgical microscope), FS-guided gross total resection (GTR) was achieved in 74.1% and subtotal resection (STR) in 11.1%. No side effects of FS were reported. Conclusion: FS-guided resection of HGGs under the YELLOW 560nm surgical microscope filter was eﬀective and safe.

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Fluorescence-Guided Surgery for High-Grade Gliomas: State of the Art and New Perspectives

Cited by 26 publications

References 98 publications

The Relevant Role of Navigated Tractography in Speech Eloquent Area Glioma Surgery: Single Center Experience

The Relevant Role of Navigated Tractography in Speech Eloquent Area Glioma Surgery: Single Center Experience

Tumor Cell Infiltration into the Brain in Glioblastoma: From Mechanisms to Clinical Perspectives

Evaluation of the effect of fluorescein sodium-guided under yellow 560nm surgical microscope filter in surgery for high grade gliomas: Preliminary results in a series of 27 patients

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