Abstract
Objective: the purpose of this study was to assess the usefulness and accuracy of visualization of glial brain tumors of varying degrees of malignancy when surgically removed with fluorescent control of fotoditazine. Evaluation of the edges of tumor tissue was also carried out in order to increase the degree gross total resection (GTR), and to evaluate the specificity and sensitivity of the fluorescence method. Design and methods: thirty one glial tumor patients, with varying degrees of malignancy, underwent controlled fluorescence-guided resection in the presence of the indicator molecule fotoditazine. To detect fluorescence, a OHS-1 operating microscope Leica with a special fluorescence module was used. Evaluation of the efficacy, sensitivity and specificity of the method was assessed using various histo-morphological studies. GTR was assessed using postoperative MRI. Results: for grade I and II gliomas, the sensitivity of the surgical tumor removal method was 68.3%, and the specificity was 60.1%. For grade III and IV gliomas, the sensitivity of the surgical tumor removal method was 85.4%, and the specificity was 76.2%. The extent to which total surgical resection was achieved was 79.3% in grade I-II and 95.6% in grade III-IV. Conclusions: intraoperative fluorescent imaging with fotoditazine is a highly effective, sensitive, and specific method which permits glial tumors of various histologic types to be resected more completely and effectively.
Highlights
In addition to patient age, functional status, tumor localization, and the degree of malignancy, one of the main factors determining patient outcome is the completeness of tumor removal [1]
Many authors report that fluorescence-controlled resection permits more thorough tumor removal and improves quality of life compared to traditional glioma surgery [9,10,11]
A 4-point scale was used for visual assessment of fluorescence intensity: 0 = no visible fluorescence (-); 1 = dim red light (+); 2 = red glow (++); 3 = bright red glow (+++)
Summary
In addition to patient age, functional status, tumor localization, and the degree of malignancy, one of the main factors determining patient outcome is the completeness of tumor removal [1]. Various methods are used in order to identify glioma boundaries during brain surgery. In terms of tumor resection, intraoperative photodiagnosis is not an additional method; it may, be the best method [3,4,5,6,7,8]. Many authors report that fluorescence-controlled resection permits more thorough tumor removal and improves quality of life compared to traditional glioma surgery [9,10,11]
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