Sweeney Jared F, Rosoklija Gavril, Sheldon Breanna L, Bondoc Melanie, Bandlamuri Sruti, Adamo Matthew A
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
J Clin Neurosci. 2022 Dec;106:141-144. doi: 10.1016/j.jocn.2022.10.019. Epub 2022 Oct 27.
Various intraoperative neuroimaging modalities are available to the neurosurgeon during brain tumor surgery. There remains no consensus on which modalities are superior. This retrospective, single-center cohort study directly compares sodium fluorescein (SF) and intraoperative ultrasonography (IOUS) as intraoperative imaging modalities in a sample of patients with glioblastoma isocitrate dehydrogenase 1 wildtype (GBM). Adult patients with GBM who underwent surgical resection using SF or IOUS guidance between 2010 and 2020 were included. Primary outcomes included extent of resection (EOR), post-operative residual tumor volume, gross total resection (GTR) rate, false negative assessments, and the incidence of new post-operative neurologic deficits. Additionally, pre-and post-test probabilities were calculated to assess each modality's ability to identify residual tumor. 98 patients met inclusion criteria (34 SF and 64 IOUS). Mean EOR was significantly higher for SF (94 ± 11 %) when compared to IOUS (87 ± 20 %; p = 0.032). Mean post-operative residual tumor was significantly higher for IOUS (197 ± 358 mm2) when compared to SF (81 ± 161mm; p = 0.038). GTR was more frequent with SF (62 % vs 46 %, p = 0.12). False negative assessments for residual tumor were more common with IOUS (22 % vs 15 %, p = 0.53). One patient in each group suffered a new neurologic deficit post-operatively (p = 0.58). Sensitivity, specificity, positive predictive value, and negative predictive value were 62 %, 100 %, 100 %, and 81 % for SF and 59 %, 100 %, 100 %, and 67 % for IOUS, respectively. Taken together, SF may be superior to IOUS in maximizing EOR in patients with GBM, however, both modalities appear to have good efficacy.
在脑肿瘤手术过程中，神经外科医生可使用多种术中神经成像方式。对于哪种方式更具优势，目前尚无共识。这项回顾性单中心队列研究直接比较了荧光素钠（SF）和术中超声检查（IOUS）在异柠檬酸脱氢酶1野生型胶质母细胞瘤（GBM）患者样本中作为术中成像方式的效果。纳入了2010年至2020年间使用SF或IOUS引导进行手术切除的成年GBM患者。主要结局包括切除范围（EOR）、术后残留肿瘤体积、全切除（GTR）率、假阴性评估以及术后新发神经功能缺损的发生率。此外，还计算了检验前概率和检验后概率，以评估每种方式识别残留肿瘤的能力。98名患者符合纳入标准（34例使用SF，64例使用IOUS）。与IOUS（87±20%）相比，SF的平均EOR显著更高（94±11%；p=0.032）。与SF（81±161mm³）相比，IOUS的平均术后残留肿瘤显著更大（197±358mm²；p=0.038）。SF组的GTR更常见（62%对46%，p=0.12）。IOUS对残留肿瘤的假阴性评估更常见（22%对15%，p=0.53）。每组各有1例患者术后出现新发神经功能缺损（p=0.58）。SF的敏感性、特异性、阳性预测值和阴性预测值分别为62%、100%、100%和81%，IOUS分别为59%、100%、100%和67%。总体而言，在使GBM患者的EOR最大化方面，SF可能优于IOUS，然而，两种方式似乎都有良好的疗效。
