Lovato Renan Maximilian, Vitorino Araujo João Luiz, Esteves Veiga José Carlos
Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil.
Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil; Arnaldo Vieira de Carvalho Cancer Institute, Oncocenter, Hospital Nove de Julho, Hospital Bandeirantes, and Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
World Neurosurg. 2017 Aug;104:61-67. doi: 10.1016/j.wneu.2017.04.169. Epub 2017 May 6.
Gross total resection for malignant brain neoplasms is challenging owing to the heterogeneity of these lesions and infiltration in eloquent areas. Gross total resection is a very important part of treatment of these patients and is a crucial prognostic factor. Fluorescence-guided surgery is an important tool that improves the rate of total resection.
We built a device to use in surgical microscopes with an excitation and a barrier filter to perform fluorescence-guided surgery. All patients received a standard dose of 500 mg of sodium fluorescein before skin incision. Surgical view under white light was compared with use of the light filters.
In all cases with use of the filters, the tumors showed a high fluorescence contrasting with the normal surrounding brain, making it easier to identify the limits of the lesion and to achieve gross total resection.
The use of fluorescence for malignant brain tumor resection increases the rate of gross total resection. It is an important tool that makes it possible to identify the lesion in areas where it looks like normal tissue under white light. This device is a low-cost option that has shown good results in our experience.
由于恶性脑肿瘤病变的异质性以及在功能区的浸润，实现肿瘤全切除具有挑战性。肿瘤全切除是这些患者治疗的非常重要的一部分，并且是一个关键的预后因素。荧光引导手术是提高全切除率的重要工具。
我们制造了一种用于手术显微镜的装置，该装置带有激发滤光片和阻挡滤光片以进行荧光引导手术。所有患者在皮肤切开前均接受500mg荧光素钠的标准剂量。将白光下的手术视野与使用滤光片后的视野进行比较。
在所有使用滤光片的病例中，肿瘤呈现出与周围正常脑组织形成鲜明对比的高荧光，这使得更容易识别病变边界并实现肿瘤全切除。
使用荧光进行恶性脑肿瘤切除可提高肿瘤全切除率。它是一种重要工具，使得在白光下看似正常组织的区域中识别病变成为可能。根据我们的经验，该装置是一种低成本选择，已显示出良好效果。
