Sabel Michael, Staub-Bartelt Franziska, Tödter Jonas, Steinmann Julia, Jeising Sebastian, Pauck David, Rapp Marion
Center of Neurooncology, Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
Center of Neurooncology, Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
World Neurosurg. 2025 Jun;198:123967. doi: 10.1016/j.wneu.2025.123967. Epub 2025 Apr 9.
Until recently, a prerequisite for fluorescence-guided surgery (FGS) was the use of a specialized microscope. With the availability of a system that combines surgical loupes with an FGS-enabled headlamp, the standard approach to FGS of gliomas is challenged. We therefore investigated the potential change in practice of FGS for gliomas, if the surgeon had the choice between both systems.
Patients with a lesion indicating FGS were included. Surgery was performed by 3 specialized neurooncological neurosurgeons, who were provided with a headlamp-loupe system (HLLS) (5-aminolevulinic acid headlamp and surgeon-adapted loupes, 3.5X, customized fitted). We recorded surgeons' choice between HLLS and microscope and semi-quantified the statements. Additionally, in one case, specificity and sensitivity of various protoporphyrin IX (PpIX) fluorescence (PpIX-f) were histopathologically evaluated.
We report 206 procedures in 198 patients. Surgeons opted in 194 (94%) of the cases for HLLS and did not switch from HLLS to microscope in any case. Three biopsies taken from areas with negative, faint, and highly positive PpIX-f, as revealed by the HLLS but not by the microscope, corresponded to normal brain tissue (negative PpIX-f), infiltration zone (faint PpIX-f), and highly cellular tumor tissue with microvascular proliferation (strong PpIX-f).
Our center changed the practice of FGS by switching from microscopes to loupes. The reported experience might have an important impact on the general use and availability of FGS, as the HLLS and the in-house preparation of 5-aminolevulinic acid come at a fraction of the costs of the commonly practiced approach.
直到最近，荧光引导手术（FGS）的一个先决条件是使用专门的显微镜。随着一种将手术放大镜与具备FGS功能的头灯相结合的系统的出现，胶质瘤FGS的标准方法受到了挑战。因此，我们研究了如果外科医生可以在这两种系统之间进行选择，胶质瘤FGS的实际操作可能会发生的变化。
纳入有FGS指征病变的患者。手术由3名专业神经肿瘤神经外科医生进行，他们配备了头灯放大镜系统（HLLS）（5-氨基乙酰丙酸头灯和适合外科医生的3.5倍放大镜，定制适配）。我们记录了外科医生在HLLS和显微镜之间的选择，并对相关陈述进行了半定量。此外，在一个病例中，对各种原卟啉IX（PpIX）荧光（PpIX-f）的特异性和敏感性进行了组织病理学评估。
我们报告了198例患者的206例手术。在194例（94%）病例中，外科医生选择了HLLS，并且在任何情况下都没有从HLLS切换到显微镜。从HLLS显示但显微镜未显示的阴性、弱阳性和强阳性PpIX-f区域采集的3份活检样本分别对应正常脑组织（阴性PpIX-f）、浸润区（弱阳性PpIX-f）和伴有微血管增生的高细胞肿瘤组织（强阳性PpIX-f）。
我们中心通过从显微镜切换到放大镜改变了FGS的操作。所报告的经验可能会对FGS的普遍使用和可及性产生重要影响，因为HLLS和5-氨基乙酰丙酸的内部制备成本仅为常用方法的一小部分。
