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  • Fluorescence-Guided Resection of Glioma

    Final Number:

    Artemii Y Rynda BS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Diffusely infiltrating gliomas represent one of the most common primary brain tumors that are classified according to histopathological criteria in slow growing low-grade gliomas and rapidly progressive high-grade gliomas. Neurosurgical resection is the primary treatment in the majority of these gliomas. Fluorescence-guided resection(FGR) is a technique used to enhance visualization of tumor margins in order to increase the extent of tumor resection in glioma surgery.

    Methods: For visualization of chlorine e6) fluorescence during neurosurgical procedures, we use at our department intravenous solutions body weight. Generally, 1mg/kg bodyweight are administered intravenous approximately 2 hours before induction of anesthesia. Dosage form: concentrate for the preparation of a solution for infusions of 50 mg / 10 ml (5 mg / ml) in bottles of dark brown glass. The Leyca OHS-1 microscope (Germany), equipped with a fluorescent attachment, was used to determine the fluorescence of chlorin e6. It consists of a specialized blue light illuminator (387-447 nm). During fluorescence-guided brain tumor resections, the light source can be switched from normal to blue light repeatedly. The connected camera and video system was adapted to detect Chlorine e6 fluorescence with high sensitivity for documentation purposes. Efficiency, sensitivity and specificity of a method, gross total resection in relation to surgery of gliomas was estimated.

    Results: For surgery of gliomas of Grade I-II sensitivity method – 68,3%, specificity – 60,1%. For surgery of gliomas of Grade III-IV sensitivity method – 85,4%, specificity – 76,2%. Extent of achievement of GTR (gross total resection) in surgery of gliomas of Grade I-II – 79,3%, for surgery of gliomas of Grade III-IV – 95,6%.

    Conclusions: Intraoperative fluorescent diagnostics with use of chlorin e6 in surgery of glial tumors of various histologic structure is a highly effective, highly sensitive and highly specific method, that allows to increase gross total resection of glial tumors.

    Patient Care: improve gross total resection,a decrease in the interrepid interval,increase in median survival

    Learning Objectives: We evaluated 31 patients undergoing microscopic fluorescence- guided resection for cerebral lesions suggestive of high- and low-grade gliomas, aiming for better intraoperative visualization of tumor and adjacent tissue . By using chlorin e6, we hoped for more rapid surgery due to the better visualization of tumor tissue, while operating on a brighter background, as previously reported.

    References: 1.Eljamel S., Michael R. 5-ALA Fluorescence Image Guided Resection of Glioblastoma Multiforme: A Meta-Analysis of the Literature // Int. J. Mol. Sci. 2015. Vol.16, ?5. P.10443–10456. 2. .Jaber M., Wolfer J., Ewelt C. The value of 5-aminolevulinic acid in low-grade gliomas and high-grade gliomas lacking glioblastoma imaging features: an analysis based on fluorescence, magnetic resonance imaging, 18F-fluoroethyl tyrosine positron emission tomography, and tumor molecular factors // Neurosurgery. 2016. Vol.78, ?3. P.401–411. 3. Kaneko S. Fluorescence-Guided Resection of Malignant Glioma with 5-ALA // International Journal of Biomedical Imaging. 2016. Vol.11, ?2. P.1–11. 4..Su X., Huang Q.F., Chen H.L., Chen J. Fluorescence-guided resection of high-grade gliomas: A systematic review and meta-analysis // Photodiagn. Photodyn. Ther. 2014. ?11. P.451–458.

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