荧光图像引导神经外科手术。
Fluorescence image-guided neurosurgery.
机构信息
Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, No. 7-20, 15-chome, 1-jyou, Tsukisamuhigashi, Toyohira-ku, Sapporo, Hokkaido 062-5813, Japan.
Neurosciences, HTNMS, 20/22 Torphichen Street, Edinburgh, EH3 8JB, UK.
出版信息
Future Oncol. 2017 Nov;13(26):2341-2348. doi: 10.2217/fon-2017-0194. Epub 2017 Nov 10.
Surgery plays an important role in the management of high-grade gliomas (HGG) and imparts significant tumor-free and overall survival advantages. However HGG margins are often invisible, making their gross total resection (GTR) a difficult task. Hence intraoperative technology such as intraoperative fluorescence was a revolutionary discovery. A critical literature review revealed fluorescence improved the GTR of HGG from 36% using standard surgery to 74.5 and 84.4% using aminolevulinic acid (ALA) or fluorescein (FLCN), respectively. The differences between ALA-fluorescence image-guided neurosurgery (FIGS) and FLCN-FIGS in HGG were not statistically significant. However, the cost per quality added life years was US$16,218 and US$3181 for ALA-FIGS and FLCN-FIGS, respectively. Therefore, FIGS provided a reliable intraoperative tumor marker. Both ALA- and FLCN-FIGS significantly improved GTR and were cost-effective.
手术在高级别胶质瘤（HGG）的治疗中起着重要作用，能显著提高无肿瘤生存率和总生存率。然而，HGG 边界往往不可见，因此要实现全切（GTR）非常困难。因此，术中荧光等术中技术是一项革命性的发现。一项关键性文献回顾显示，荧光技术可将 HGG 的 GTR 从标准手术的 36%提高到使用氨基乙酰丙酸（ALA）或荧光素（FLCN）时的 74.5%和 84.4%。ALA 荧光引导神经外科手术（FIGS）和 FLCN-FIGS 在 HGG 中的差异无统计学意义。然而，ALA-FIGS 和 FLCN-FIGS 每增加 1 个质量调整生命年的成本分别为 16218 美元和 3181 美元。因此，FIGS 提供了一种可靠的术中肿瘤标志物。ALA 和 FLCN-FIGS 均能显著提高 GTR，且具有成本效益。
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