Abstract
Fluorescence diagnostics is one of the promising methods for intraoperative detection of brain tumor boundaries and helps in maximizing the extent of resection. This paper presents the results of a pilot study on the first use of the chlorin e6 photosensitizer and a two-channel video system for fluorescence-guided resection of pituitary adenomas. The study’s clinical part involved two patients diagnosed with hormonally inactive pituitary macroadenomas and one patient with a hormonally active one. All neoplasms had different sizes and growth patterns. The data showed accumulation of chlorin e6 in tumor tissues in high concentrations: Patient 1: 2 mg/kg, Patient 2: 5 mg/kg, and Patient 3: 4 mg/kg. For Patient 1, the residual part of the tumor was not resected since it was intimately attached to the anterior genu of the internal carotid artery. For Patients 2 and 3, no regions of increased Ce6 accumulation were detected in the tumor foci after resection. Therefore, the use of the Ce6 and a two-channel video system helped to achieve a high degree of tumor resection in each case.
Highlights
IntroductionEndoscopic transnasal transsphenoidal access has become the gold standard in the surgical treatment of patients with Pituitary adenomas (PAs), almost completely replacing transcranial and transnasal approaches performed with a microscope [2,3]
Pituitary adenomas (PAs) are benign neoplasms and account for 10–15% of all intracranial primary brain neoplasms [1].In recent years, endoscopic transnasal transsphenoidal access has become the gold standard in the surgical treatment of patients with PAs, almost completely replacing transcranial and transnasal approaches performed with a microscope [2,3]
This paper presented clinical results of the first use of Chlorin e6 (Ce6) PS and a two-channel video system for fluorescence-guided resection of PAs performed on three patients with different tumor sizes and growth patterns
Summary
Endoscopic transnasal transsphenoidal access has become the gold standard in the surgical treatment of patients with PAs, almost completely replacing transcranial and transnasal approaches performed with a microscope [2,3]. The extent of resection of both hormonally active and inactive tumors is a key criterion for a patient’s recovery and determination of prognosis of disease remission [4]. Two of the main points complicating radical tumor resection are its infiltrative growth pattern and its intraoperative ability to determine areas of tumor infiltration [5]. To increase the completeness of adenomas’ resection, there exist such techniques as dissection of the dura mater (DM), coagulation, and resection of DM parts with tumor infiltration. The problems of intraoperative determination of the neoplasm boundaries with the presence of infiltrative growth in the surrounding structures remain unsolved
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