Panciani Pier Paolo, Fontanella Marco, Schatlo Bawarjan, Garbossa Diego, Agnoletti Alessandro, Ducati Alessandro, Lanotte Michele
Division of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15 - 10126 Torino, Italy.
Clin Neurol Neurosurg. 2012 Jan;114(1):37-41. doi: 10.1016/j.clineuro.2011.09.001. Epub 2011 Sep 29.
The extent of resection in high grade glioma is increasingly been shown to positively effect survival. Nevertheless, heterogeneity and migratory behavior of glioma cells make gross total resection very challenging. Several techniques were used in order to improve the detection of residual tumor. Aim of this study was to analyze advantages and limitations of fluorescence and image guided resection. A multicentric prospective study was designed to evaluate the accuracy of each method. Furthermore, the role of 5-aminolevulinc acid and neuronavigation were reviewed. Twenty-three patients harboring suspected high grade glioma, amenable to complete resection, were enrolled. Fluorescence and image guides were used to perform surgery. Multiple samples were obtained from the resection cavity of each lesion according to 5-ALA staining positivity and boundaries as delineated by neuronavigation. All samples were analyzed by a pathologist blinded to the intra-operative labeling. Decision-making based on fluorescence showed a sensitivity of 91.1% and a specificity of 89.4% (p<0.001). On the other hand, the image-guided resection accuracy was low (sensitivity: 57.8%; specificity: 57.4%; p=0.346). We observed that the sensitivity of 5-ALA can be improved by the combined use of neuronavigation, but this leads to a significant reduction in specificity. Thus, the use of auxiliary techniques should always be subject to critical skills of the surgeon. We advocate a large-scale study to further improve the assessment of multimodal approaches.
越来越多的研究表明，高级别胶质瘤的切除范围对生存率有积极影响。然而，胶质瘤细胞的异质性和迁移行为使得全切手术极具挑战性。为了提高对残留肿瘤的检测，人们采用了多种技术。本研究的目的是分析荧光和图像引导切除的优缺点。我们设计了一项多中心前瞻性研究来评估每种方法的准确性。此外，还回顾了5-氨基乙酰丙酸和神经导航的作用。纳入了23例疑似高级别胶质瘤且适合进行全切的患者。采用荧光和图像引导进行手术。根据5-氨基乙酰丙酸染色阳性情况以及神经导航划定的边界，从每个病变的切除腔中获取多个样本。所有样本均由一位对术中标记不知情的病理学家进行分析。基于荧光的决策显示敏感性为91.1%，特异性为89.4%（p<0.001）。另一方面，图像引导切除的准确性较低（敏感性：57.8%；特异性：57.4%；p=0.346）。我们观察到，联合使用神经导航可提高5-氨基乙酰丙酸的敏感性，但这会导致特异性显著降低。因此，辅助技术的使用应始终取决于外科医生的关键技能。我们主张开展大规模研究以进一步改进多模态方法的评估。
