Fluorescein-Guided Surgery for High-Grade Glioma Resection: An Intraoperative “Contrast-Enhancer”

Catapano, Giuseppe; Sgulò, Francesco Giovanni; Seneca, Vincenzo; Lepore, Giovanni; Columbano, Laura; Nuzzo, G

doi:10.1016/j.wneu.2017.05.022

Cited by 49 publications

(33 citation statements)

References 49 publications

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“…According to the generally accepted definition, total tumour removal is achieved when neuroimaging studies confirm complete removal of contrast-enhancing regions or hyperintensive T2/FLAIR regions [ 15 ]. In order to maximise surgical resection, intraoperative MR imaging, intraoperative ultrasonography and intraoperative tumour staining can be used to maximize surgical resection [ 16 ]. Combined with the awake surgery and eloquent brain mapping the complete glioma resection is up to 96% [ 17 ].…”

Section: Surgery and New Surgical Approachesmentioning

confidence: 99%

Clinical and immunological correlates of long term survival in glioblastoma

Czapski¹,

Baluszek²,

Herold‐Mende³

et al. 2018

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Glioblastoma (GBM) is the most common and most aggressive type of primary brain tumour in adults. It represents 54% of all gliomas and 16% of all brain tumours (Ostrom et al. 2016). Despite surgery and treatment with radiotherapy plus an oral alkylating agent, temozolomide (TMZ), tumours invariably recur, and the patient survival is an average of ~14–16 months. In this review we summarise the current understanding of multiple factors that may affect survival of patients with GBMs. In particular, we discuss recent advancements in surgery and detection of genomic-based markers with prognostic values, such as IDH1/2 mutations, MGMT gene promoter methylation, and TERT gene promoter alterations. We address the issue of tumour heterogeneity and evolution that may result in different parts of the same tumour exhibiting different GBM subtypes and in subtype switching, which may restrict the usefulness of the expression-based classification as a prognostic marker before relapse. The determinants of long-term survival in patients with IDH1/2wt GBM, beyond MGMT promoter methylation, remain to be identified, and even the absence of both IDH1/2 mutations and MGMT promoter methylation does not preclude long-term survival. These findings suggest that host-derived factors, such as immune system responsiveness may contribute to long-term survival in such patients. We report the results of high-throughput approaches, suggesting links between long-term survival and enhanced immune-related gene expression. The further search for new gene candidates, promoter methylation status, and specific features of host immunity should provide prognostic biomarkers for the evaluation of survival of IDH1 wild-type/non-G-CIMP GBMs.

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Section: Surgery and New Surgical Approachesmentioning

confidence: 99%

Clinical and immunological correlates of long term survival in glioblastoma

Czapski¹,

Baluszek²,

Herold‐Mende³

et al. 2018

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“…26,27 At the end of resection, we investigated the consistency between the fluorescein guide and neuronavigation guide. In most cases, we found strong correspondence between the fluorescein-demonstrated border and the contrast-enhancing tumor margin on intraoperative navigation, 28,29 except for two cases in which the navigation system lost its reliability and accuracy due to brain shifting or other reasons.…”

Section: Discussionmentioning

confidence: 81%

Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

et al. 2018

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Brainstem gliomas (BsG) account for 10 to 15% of pediatric brain tumors. Surgery is the preferred treatment for focal and exophytic lesions. Sodium fluorescein has been proven safe and effective in resection of malignant brain tumors. The objective was to o analyze the safety and effectiveness of this approach, to evaluate intraoperative fluorescein imaging, and to measure the safety of chosen dose for pediatric patients. Twelve cases were enrolled between March 2014 and September 2016 in Beijing Tiantan Hospital. All of the patients received 2.5 mg/kg of sodium fluorescein before opening the dura; the intraoperative fluorescence enhancement was observed, and the degree of satisfaction and consistency with the neuronavigation were evaluated. With a mean age of 7.5 years, there were eight cases located within the pontine, three in the medullary oblongata, and one in the tectal plate. Histological results were astrocytoma, glioblastoma, oligodendroglioma, and pilocytic astrocytoma. Under the fluorescein module of the microscope, the tumors were recognizable enough to help surgeons to discriminate the lesion from non-fluorescent tissue, with a consistency of 83% with the neuronavigation. Total removal was accomplished in nine cases, while the mean percentage of resection of the other cases was 93.7%. The Karnofsky performance score (KPS) showed no significant differences between pre-operation and discharge, but there was a difference between pre-operation and 6-month follow-up. The fluorescein-guided surgery is useful for demarcating the tumor margin and works well with other navigation and monitoring devices. A safe dose of sodium fluorescein (2.5 mg/kg) was proven effective for children.

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“…In the US, Gliolan was filed for new drug application in 2016 as an optical imaging agent and approved in 2017 in high-grade glioma patients (WHO grade III or IV) as an adjunct for the visualization of malignant tissue during surgery. [71] 5-ALA is a natural biochemical precursor of hemoglobin that prompts the synthesis and accumulation of fluorescent porphyrins in malignant tumors. [72] Porphyrin fluorescence can be then excited by filtered light and visualized with a modified microscope.…”

Section: Contrast Agents For Optical Imagingmentioning

confidence: 99%

“…[114] Interestingly, the incremental costs for the four different modalities were all under the threshold of cost effectiveness for high-grade glioma therapy. [71] This means combining these modalities, or even developing new modalities can be adopted for better surgical outcomes. The key to achieving total resection of gliomas is the clear delineation of tumor margins, but the modalities discussed above have a lack of histological correlation and have limited access to the cellular level.…”

Section: Multimodal Brain Tumor Imagingmentioning

confidence: 99%

Real‐Time Imaging of Brain Tumor for Image‐Guided Surgery

Kang

Baek

et al. 2018

Adv Healthcare Materials

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The completion of surgical resection is a key prognostic factor in brain tumor treatment. This requires surgeons to identify residual tumors in theater as well as to margin the proximity of the tumor to adjacent normal tissue. Subjective assessments, such as texture palpation or visual tissue differences, are commonly used by oncology surgeons during resection to differentiate cancer lesions from normal tissue, which can potentially result in either an incomplete tumor resection, or accidental removal of normal tissue. Moreover, malignant brain tumors are even more difficult to distinguish from normal brain tissue, and resecting noncancerous tissue may create neurological defects after surgery. To optimize the resection margin in brain tumors, a variety of intraoperative guidance techniques are developed, such as neuronavigation, magnetic resonance imaging, ultrasound, Raman spectroscopy, and optical fluorescence imaging. When combined with appropriate contrast agents, optical fluorescence imaging can provide the neurosurgeon real-time image guidance to improve resection completeness and to decrease surgical complications.

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Fluorescein-Guided Surgery for High-Grade Glioma Resection: An Intraoperative “Contrast-Enhancer”

Cited by 49 publications

References 49 publications

Clinical and immunological correlates of long term survival in glioblastoma

Clinical and immunological correlates of long term survival in glioblastoma

Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

Real‐Time Imaging of Brain Tumor for Image‐Guided Surgery

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