Panciani Pier Paolo, Fontanella Marco, Garbossa Diego, Agnoletti Alessandro, Ducati Alessandro, Lanotte Michele
Division of Neurosurgery, Department of Neuroscience, University of Turin, Italy.
Neurocirugia (Astur). 2012 Feb;23(1):23-8. doi: 10.1016/j.neucir.2012.04.003.
In high-grade glioma surgery, several techniques are used to achieve the maximum cytoreductive treatment preserving neurological functions. However, the effectiveness of all the methods used alone is reduced by specific limitations of each. We assessed the reliability of a multimodal strategy based on 5-aminolevulinic acid (5-ALA) and neuronavigation. We prospectively studied 18 patients with suspected, non eloquent-area malignant gliomas amenable for complete resection. Conventional illumination was used until the excision appeared complete. The cavity was then systematically inspected in violet-blue light to identify any residual tumour. Multiple biopsies of both fluorescent and non-fluorescent tissue were performed in all cases. Each specimen was labelled according to the sampling location (inside or outside the boundary set by the neuronavigator). The samples were analysed by a neuropathologist blinded to the intraoperative classification. We reviewed the results of both methods, either singly or in combination. Individual analysis showed higher 5-ALA reliability compared to neuronavigation. However, several false-negative fluorescent specimens were detected. With the combined use of fluorescence and neuroimaging, only 1 sample (negative for both 5-ALA and navigation) was tumoral tissue. In our experience, the combined approach showed the best sensitivity and it is recommended in cases of lesions involving non-eloquent areas.
在高级别胶质瘤手术中，会采用多种技术来实现最大限度的肿瘤细胞减灭治疗，同时保留神经功能。然而，单独使用的所有方法的有效性都会因各自的特定局限性而降低。我们评估了基于5-氨基乙酰丙酸（5-ALA）和神经导航的多模式策略的可靠性。我们前瞻性地研究了18例疑似非功能区恶性胶质瘤且适合进行完整切除的患者。在切除看似完成之前，使用传统照明。然后在紫蓝光下系统检查腔隙，以识别任何残留肿瘤。在所有病例中，对荧光和非荧光组织均进行多次活检。每个标本根据采样位置（神经导航仪设定的边界内或外）进行标记。样本由一位对术中分类不知情的神经病理学家进行分析。我们回顾了两种方法单独或联合使用的结果。单独分析显示，与神经导航相比，5-ALA的可靠性更高。然而，检测到了一些假阴性的荧光标本。联合使用荧光和神经影像学检查时，只有1个样本（5-ALA和导航检查均为阴性）是肿瘤组织。根据我们的经验，联合方法显示出最佳的敏感性，对于累及非功能区的病变，建议采用该方法。
