Jacquesson T, Ducray F, Maucort-Boulch D, Armoiry X, Louis-Tisserand G, Mbaye M, Pelissou-Guyotat I, Guyotat J
Service de neurochirurgie D, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron cedex, France.
Neurochirurgie. 2013 Feb;59(1):9-16. doi: 10.1016/j.neuchi.2012.07.002. Epub 2013 Jan 12.
Optimal surgical resection improves the prognosis of glioblastomas. However, this goal is far from being achieved due to its invasive nature. Several studies have already shown the efficacy of fluorescence-guided surgery, in improving the quality of resection of glioblastoma. We report herein our experience through a retrospective serie and describe the principles, limitations and advantages of this technique.
Between 2006 and 2009, 22 patients underwent resection of a glioblastoma guided by fluorescence. Following operations, all patients underwent sequential clinical examination and radiological monitoring using multimodal MRI. The extent of resection was assessed by the surgeon during the procedure and by the radiologist on MRI. The curves of progression-free clinical survival (SSP) and overall survival (SG) were analyzed. The prognostic value of the extent of resection was studied.
We obtained 68.2% of complete resection according to the absence of residual fluorescence as assessed by the surgeon, and 75% according to the absence of residual tumor on early MRI. The median SSP was 10.75 months and the median SG was 17 months. Complete tumoral resection confirmed by loss of fluorescence significatively increases the median SSP of 6.7 months to 12.9 months (p=0.001559) and the median SG of 12.3 months to 20.9 months (p=0.000559). After 1 year, 81.8% of patients were still alive.
Our study confirms the use of fluorescence as an effective method to allow optimal resection of glioblastoma. In addition to neuronavigation, surgical experience, vision and proprioception, fluorescence contributes to achieve a complete tumor resection.
最佳手术切除可改善胶质母细胞瘤的预后。然而，由于其浸润性，这一目标远未实现。多项研究已表明荧光引导手术在提高胶质母细胞瘤切除质量方面的有效性。我们在此报告通过回顾性系列研究的经验，并描述该技术的原理、局限性和优势。
2006年至2009年期间，22例患者接受了荧光引导下的胶质母细胞瘤切除术。术后，所有患者均接受了序贯临床检查，并使用多模态磁共振成像（MRI）进行影像学监测。手术过程中由外科医生评估切除范围，术后由放射科医生通过MRI评估。分析无进展临床生存期（SSP）和总生存期（SG）曲线。研究切除范围的预后价值。
根据外科医生评估无残留荧光，我们获得了68.2%的完全切除率；根据早期MRI无残留肿瘤，完全切除率为75%。SSP中位数为10.75个月，SG中位数为17个月。荧光消失证实的肿瘤完全切除显著将SSP中位数从6.7个月提高到12.9个月（p = 0.001559），将SG中位数从12.3个月提高到20.9个月（p = 0.000559）。1年后，81.8%的患者仍存活。
我们的研究证实荧光作为一种有效方法可实现胶质母细胞瘤的最佳切除。除神经导航、手术经验、视觉和本体感觉外，荧光有助于实现肿瘤的完全切除。
