Background and Objective: Total tumor resection in patients with glioblastoma multiforme (GBM) is difficult to achieve due to the tumor's infiltrative way of growing and morphological similarity to the surrounding functioning brain tissue. The diagnosis is usually subjectively performed using a surgical microscope. The objective of this study was to develop and evaluate a hand-held optical touch pointer using a fluorescence spectroscopy system to quantitatively distinguish healthy from malignant brain tissue intraoperatively. Study Design/Materials and Methods:A fluorescence spectroscopy system with pulsed modulation was designed considering optimum energy delivery to the tissue, minimal photobleaching of PpIX and omission of the ambient light background in the operating room (OR). 5-aminolevulinic acid (5-ALA) of 5 mg/kg body weight was given to the patients with a presumed glioblastoma multiforme prior to surgery. During the surgery a laser pulse at 405 nm was delivered to the tissue. PpIX in glioblastoma tumor cells assigned with peaks at 635 nm and 704 nm was detected using a fiber optical probe.Results/Conclusion: By using the pulsed fluorescence spectroscopy, PpIX fluorescence is quantitatively detected in the glioblastoma multiforme. An effective suppression of low power lamp background from the recorded spectra in addition to a significant reduction of high power surgical lights is achieved.

A series of experiments has been conducted with probes made from silicon, glass, tungsten and polyimide within a developed brain phantom, and the insertion behavior, forces and dimpling are compared to in vitro and in vivo models. This allows the choice of proper insertion parameters and probe structure to reach a compromise between needle stability and tissue trauma as a result of insertion. According to the performed experiments, the reduced interfacial area between the needle tip and the brain will result in reduced insertion force. High insertion speed (100 mm/min) reduces the dimpling but not the penetration force necessarily. In vivo insertion and retraction of the fragile probes made from silicon is possible without pia and/or dura removal.

The probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone.

Aim: The aim of this study is to assess reflected light intensity combined with impedance as a navigation aid during stereotactic neurosurgery. Methods: During creation of 21 trajectories for stereotactic implantation of deep brain stimulation electrodes in the globus pallidus internus or subthalamus (zona incerta or subthalamic nucleus), impedance at 512 kHz and reflected light intensity at 780 nm were measured continuously and simultaneously with a radio frequency electrode containing optical fibres. The signals were compared with the anatomy, determined from pre- and post-operative MRI and CT. The measurements were performed within minutes, and signal analysis was done post-operatively. Results: Reflected light intensity was low from the cortex, lateral ventricle, caudate nucleus and putamen; intermediate from the globus pallidus and thalamus; while it was high from the subcortical white matter, internal capsule and subthalamus. The electrical impedance was less consistent, but generally low in the cortex, intermediate in the subcortical white matter, putamen, globus pallidus and thalamus, and high in the internal capsule and subthalamus. Conclusion: Reflected light intensity and electrical impedance give complementary information about passed tissue, and the combination seems promising as a navigation aid during stereotactic neurosurgery.