Höhne Julius, Acerbi Francesco, Falco Jacopo, Akçakaya Mehmet Osman, Schmidt Nils Ole, Kiris Talat, de Laurentis Camilla, Ferroli Paolo, Broggi Morgan, Schebesch Karl-Michael
Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy.
J Clin Med. 2020 Jul 28;9(8):2405. doi: 10.3390/jcm9082405.
(1) Background: Gangliogliomas comprise a small number of brain tumors. They usually present as World Health Organization (WHO) grade I, and they delineate on gadolinium-enhanced MRI; the surgical goal is wide radical resection, and the course thereafter is usually benign. Fluorescein sodium (FL) tends to accumulate in areas with altered blood-brain barrier (BBB). Thus far, the results provided by prospective and retrospective studies show that the utilization of this fluorophore may be associated with better visualization and improvement of resection for several tumors of the central nervous system. In this study, we retrospectively studied the effect of fluorescein sodium on visualization and resection of gangliogliomas. (2) Methods: Surgical databases in three neurosurgical departments (Regensburg University Hospital; Besta Institute, Milano, Italy; and Liv Hospital, Istanbul, Turkey), with approval by the local ethics committee, were retrospectively reviewed to find gangliogliomas surgically removed by a fluorescein-guided technique by the aid of a dedicated filter on the surgical microscope from April 2014 to February 2020. Eighteen patients (13 women, 5 men; mean age 22.9 years, range 3 to 78 years) underwent surgical treatment for gangliogliomas during 19 operations. Fluorescein was intravenously injected (5 mg/kg) after general anesthesia induction. Tumors were removed using a microsurgical technique with the YELLOW 560 Filter (YE560) (KINEVO/PENTERO 900, Carl Zeiss Meditec, Oberkochen, Germany). (3) Results: No side effects related to fluorescein occurred. In all tumors, contrast enhancement on preoperative MRI correlated with bright yellow fluorescence during the surgical procedure (17 gangliogliomas WHO grade I, 1 ganglioglioma WHO grade II). Fluorescein was considered helpful by the operating surgeon in distinguishing tumors from viable tissue in all cases (100%). Biopsy was intended in two operations, and subtotal resection was intended in one operation. In all other operations considered preoperatively eligible, gross total resection (GTR) was achieved in 12 out of 16 (75%) instances. (4) Conclusions: The use of FL and YE560 is a readily available method for safe fluorescence-guided tumor resection, possibly visualizing tumor margins intraoperatively similar to contrast enhancement in T1-weighted MRI. Our data suggested a positive effect of fluorescein-guided surgery on intraoperative visualization and extent of resection during resection of gangliogliomas.
（1）背景：神经节胶质瘤是一种少见的脑肿瘤。它们通常为世界卫生组织（WHO）I级，在钆增强磁共振成像（MRI）上可清晰显示；手术目标是广泛根治性切除，术后病程通常呈良性。荧光素钠（FL）倾向于在血脑屏障（BBB）改变的区域蓄积。迄今为止，前瞻性和回顾性研究结果表明，这种荧光团的应用可能有助于更好地显示几种中枢神经系统肿瘤并提高其切除率。在本研究中，我们回顾性研究了荧光素钠对神经节胶质瘤显示及切除的影响。（2）方法：经当地伦理委员会批准，对三个神经外科科室（雷根斯堡大学医院；意大利米兰贝斯塔研究所；土耳其伊斯坦布尔Liv医院）的手术数据库进行回顾性分析，以找出2014年4月至2020年2月期间通过手术显微镜上的专用滤光片采用荧光素引导技术手术切除的神经节胶质瘤。18例患者（13例女性，5例男性；平均年龄22.9岁，范围3至78岁）在19次手术中接受了神经节胶质瘤的手术治疗。全身麻醉诱导后静脉注射荧光素（5mg/kg）。使用配备YELLOW 560滤光片（YE560）（德国卡尔蔡司医疗技术公司的KINEVO/PENTERO 900）的显微外科技术切除肿瘤。（3）结果：未出现与荧光素相关的副作用。在所有肿瘤中，术前MRI上的对比增强与手术过程中的亮黄色荧光相关（17例WHO I级神经节胶质瘤，1例WHO II级神经节胶质瘤）。手术医生认为荧光素在所有病例中（100%）均有助于区分肿瘤与存活组织。2例手术计划进行活检，1例手术计划进行次全切除。在所有其他术前认为符合条件的手术中，16例中有12例（75%）实现了全切除（GTR）。（4）结论：使用FL和YE560是一种易于实施的安全的荧光引导肿瘤切除方法，术中可能类似于T1加权MRI中的对比增强那样显示肿瘤边界。我们的数据表明荧光素引导手术对神经节胶质瘤切除术中的术中显示及切除范围有积极影响。
