Gokbel Aykut, Uzuner Ayse, Yilmaz Eren, Emengen Atakan, Balci Sibel, Anik Ihsan, Ceylan Savas
Department of Neurosurgery, VM Pendik Medical Park Hospital, Istanbul, Turkey.
Department of Neurosurgery, Afsin State Hospital, Kahramanmaras, Turkey.
J Clin Neurosci. 2025 Aug;138:111404. doi: 10.1016/j.jocn.2025.111404. Epub 2025 Jun 17.
This study investigated the effectiveness of intraoperative ultrasonography (IOUS) combined with sodium fluorescein (SF) in evaluating tumor resection completeness in patients with glioblastoma IDH1-wildtype. By comparing SF with IOUS with postoperative magnetic resonance imaging (MRI) for detecting residual tumors, we aimed to evaluate its potential in improving surgical precision and neurosurgical outcomes.
Adult patients with supratentorial IDH-wildtype grade 4 glioblastoma who underwent resection using SF or SF with IOUS during 2015-2024 were included.
A total of 97 patients met the inclusion criteria (49 SF group and 48 SF with IOUS group). The gross total resection (GTR) rate was higher in the SF with IOUS group (83.3 %) than in the SF group (67.3 %), although the difference was not statistically significant (p = 0.112). For residual tumors according to postoperative MRI findings as a result of subtotal resection due to tumor invasion of eloquent anatomical locations, 6/49 (12.2 %) patients in the SF group showed a positive result (ϰ: 0.447, p = 0.001), and 4/48 (8.3 %) patients in the SF with IOUS group showed a positive result (ϰ: 0.625, p < 0.001). The sensitivity, specificity, negative predictive value, and positive predictive value for predicting residual tumors peroperatively compared with postoperative MRI results were calculated for the SF and SF with IOUS groups. Comparison between the SF and SF with IOUS groups revealed a statistically significant difference in the estimated mean survival time, with 14 months (standard error: 1.236) for the SF group and 24 months (standard error: 4.103) for the SF with IOUS group (p < 0.001). In total, 11/49 (22.4 %) patients in the SF group, and 10/48 (20.8 %) patients in the SF with IOUS group experienced newly developed neurological deficits postoperatively (p > 0.05). In the SF with IOUS group, 26/48 (54.2 %) patients, 14/48 (29.2 %) patients, and 8/48 (16.7 %) patients had Karnofsky Performance Status scores of 90-100, 70-80, and < 70, respectively (p = 0.525), and 12 patients experienced deterioration, 24 patients were stable, and 12 patients had improved at 1 month.
SF with IOUS provides a reliable imaging modality for achieving successful GTR and improving surgical outcomes. Nevertheless, further research is necessary to overcome its limitations and better define its intraoperative role.
本研究探讨术中超声（IOUS）联合荧光素钠（SF）在评估异柠檬酸脱氢酶1（IDH1）野生型胶质母细胞瘤患者肿瘤切除完整性方面的有效性。通过将SF与IOUS联合术后磁共振成像（MRI）检测残留肿瘤进行比较，我们旨在评估其在提高手术精度和神经外科手术效果方面的潜力。
纳入2015年至2024年期间接受使用SF或SF联合IOUS进行切除的幕上IDH野生型4级胶质母细胞瘤成年患者。
共有97例患者符合纳入标准（49例为SF组，48例为SF联合IOUS组）。SF联合IOUS组的全切除（GTR）率（83.3%）高于SF组（67.3%），尽管差异无统计学意义（p = 0.112）。对于因肿瘤侵犯明确解剖位置而进行次全切除后根据术后MRI结果显示的残留肿瘤，SF组6/49（12.2%）患者结果为阳性（ϰ：0.447，p = 0.001），SF联合IOUS组4/48（8.3%）患者结果为阳性（ϰ：0.625，p < 0.001）。计算了SF组和SF联合IOUS组与术后MRI结果相比术中预测残留肿瘤的敏感性、特异性、阴性预测值和阳性预测值。SF组和SF联合IOUS组之间的估计平均生存时间差异有统计学意义，SF组为14个月（标准误：1.236），SF联合IOUS组为24个月（标准误：4.103）（p < 0.001）。SF组共有11/49（22.4%）患者，SF联合IOUS组有10/48（20.8%）患者术后出现新发神经功能缺损（p > 0.05）。在SF联合IOUS组中，48例患者中26例（54.2%）、14例（29.2%）和8例（16.7%）的卡氏功能状态评分分别为90 - 100、70 - 80和<70（p = 0.525），1个月时12例患者病情恶化，24例患者病情稳定，12例患者病情改善。
SF联合IOUS为实现成功的GTR和改善手术效果提供了一种可靠的成像方式。然而，有必要进一步研究以克服其局限性并更好地明确其术中作用。
