Abstract
Background. The introduction of fluorescence-guided resection allows a better identification of tumor tissue and its more radical resection. We describe our experience with a modified exoscope to detect 5 ALA-induced fluorescence in neuronavigation-guided brain surgery or biopsy of malignant brain tumors. Methods. Thirty-eight patients with a suspected preoperative diagnosis of high-grade astrocytoma were included. We used a neuronavigation device and a high-definition exoscope system with a built-in filter to detect 5-ALA fluorescence in all cases. Thirty patients underwent craniotomy with tumor resection and 8 underwent frameless stereotactic brain biopsy. Results. Histopathological diagnosis confirmed the presence of high-grade gliomas in 34 patients. Total resection was achieved in 23 cases and subtotal in 7. No relevant complications related to the administration of 5-ALA were detected. Conclusions. The use of the exoscope in 5-ALA fluorescence-guided tumor surgery has twofold implications: during brain tumor surgery it can be considered a valuable tool to achieve a more radical resection of the lesion, and when applied to a biopsy of a suspected brain high-grade glioma, it decreases the possibility of a negative biopsy.
Highlights
High-grade gliomas represent the majority of adult malignant brain tumors and include grade III anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), mixed anaplastic oligoastrocytoma (AOA), and grade IV glioblastoma multiforme (GBM) [1]
In this report we describe our experience in the treatment of high-grade gliomas using 5-ALA fluorescence-guided exoscopy, as an alternative or complement to the use of another optical device, in order to obtain the highest level of tumor resection or to confirm the adequacy of the specimen obtained during biopsy procedures
MRI evaluation indicated that total resection was achieved in 23 cases and subtotal resection in 7 patients
Summary
High-grade gliomas represent the majority of adult malignant brain tumors and include grade III anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), mixed anaplastic oligoastrocytoma (AOA), and grade IV glioblastoma multiforme (GBM) [1]. Under the suspicious of a high-grade lesion, when a brain biopsy is indicated, the stereotactic frame biopsy is still considered the gold standard technique for its precise localization [8], specially in cases of deep seated tumors. We describe our experience with a modified exoscope to detect 5 ALA-induced fluorescence in neuronavigation-guided brain surgery or biopsy of malignant brain tumors. We used a neuronavigation device and a high-definition exoscope system with a built-in filter to detect 5-ALA fluorescence in all cases. Thirty patients underwent craniotomy with tumor resection and 8 underwent frameless stereotactic brain biopsy. The use of the exoscope in 5-ALA fluorescence-guided tumor surgery has twofold implications: during brain tumor surgery it can be considered a valuable tool to achieve a more radical resection of the lesion, and when applied to a biopsy of a suspected brain high-grade glioma, it decreases the possibility of a negative biopsy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
