Journal of Surgery
Volume 6, Issue 5, October 2018, Pages: 116-122
Received: Jul. 24, 2018;
Accepted: Aug. 15, 2018;
Published: Sep. 12, 2018
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Artemii Yurievich Rynda, Department Neurooncology, Polenov Russian Research Institute of Neurosurgery, Div. Almazov National Medical Research Centre, St. Petersburg, Russia
Dmitrii Michailovich Rostovtsev, Department Neurooncology, Polenov Russian Research Institute of Neurosurgery, Div. Almazov National Medical Research Centre, St. Petersburg, Russia
Victor Emelijanovich Olyushin, Department Neurooncology, Polenov Russian Research Institute of Neurosurgery, Div. Almazov National Medical Research Centre, St. Petersburg, Russia
Yliay Michaiylovna Zabrodskaya, Department Neurooncology, Polenov Russian Research Institute of Neurosurgery, Div. Almazov National Medical Research Centre, St. Petersburg, Russia
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.
Artemii Yurievich Rynda,
Dmitrii Michailovich Rostovtsev,
Victor Emelijanovich Olyushin,
Yliay Michaiylovna Zabrodskaya,
Fluorescence-Guided Resection of Glial Brain Tumors with Fotoditazin, Journal of Surgery.
Vol. 6, No. 5,
2018, pp. 116-122.
Eljamel S. 5-ALA Fluorescence Image Guided Resection of Glioblastoma Multiforme: A Meta-Analysis of the Literature. Int J Mol Sci. 2015; 16 (5): 10443-56.
Su X, Huang QF, Chen HL, Chen J. Fluorescence-guided resection of high-grade gliomas: A systematic review and meta-analysis. Photodiagn Photodyn Ther. 2014; 1: 451-8.
Della Puppa A, De Pellegrin S, d'Avella E, Gioffrè G, Rossetto M, Gerardi A, et al. 5-aminolevulinic acid (5-ALA) fluorescence guided surgery of high-grade gliomas in eloquent areas assisted by functional mapping. Our experience and review of the literature. Acta Neurochir. 2013; 155: 965-72.
Jacquesson T, Ducray F, Maucort-Boulch D, Armoiry X, Louis-Tisserand G, Mbaye M. Surgery of high-grade gliomas guided by fluorescence: A retrospective study of 22 patients. Neurochirurgie 2013; 59: 9-16.
Liu JT, Meza D, Sanai N. Trends in fluorescence image-guided surgery for gliomas. Neurosurgery 2014; 75 (1): 61-71.
Rynda AY, Olyushin VE, Rostovtsev DM. Fluorescence-Guided Resection of Glioma – literature review. Russian Neurosurgical Journal named after professor A. L. Polenov 2018; X (1): 91-101.
Acerbi F, Broggi M, Eoli M, Anghileri E, Cuppini L, Pollo B, et al. Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: Preliminary results in 12 cases. Acta Neurochir. 2013; 155: 1277-86.
Lau D, Hervey-Jumper SL, Chang S, Molinaro AM, McDermott MW, Phillips JJ, et al. A prospective Phase II clinical trial of 5-aminolevulinic acid to assess the correlation of intraoperative fluorescence intensity and degree of histologic cellularity during resection of high-grade gliomas. J Neurosurg. 2016; 124 (5): 1300-9.
Jaber M, Wölfer J, Ewelt C, Holling M, Hasselblatt M, Niederstadt T, et al. The value of 5-aminolevulinic acid in low-grade gliomas and high-grade gliomas lacking glioblastoma imaging features: an analysis based on fluorescence, magnetic resonance imaging, 18F-fluoroethyl tyrosine positron emission tomography, and tumor molecular factors. Neurosurgery 2016; 78 (3): P. 401-11.
Bo Chen, Haifeng Wang, Pengfei Ge, Jingwei Zhao, Wenchen Li, Huizi Gu, et al. Gross total resection of glioma with the intraoperative fluorescence-guidance of fluorescein sodium. Int J Med Sci. 2012; 9: 708-14.
Chung IW, Eljamel S. Risk factors for developing oral 5-aminolevulinic acid-induced side effects in patients undergoing fluorescence guided resection. Photodiagn Photodyn Ther. 2013; 10: 362-7.
Sadahiro Kaneko, Sadao Kaneko. Fluorescence-Guided Resection of Malignant Glioma with 5-ALA. International Journal of Biomedical Imaging 2016; 11 (2): 1-11.
Valdés PA, Kim A, Brantsch M, Niu C, Moses ZB, Tosteson TD, et al. Delta-aminolevulinic acid-induced protoporphyrin IX concentration correlates with histopathologic markers of malignancy in human gliomas: the need for quantitative fluorescence-guided resection to identify regions of increasing malignancy. Neuro Oncol. 2011; 13: 846-56.
Zheng H, Songsheng Shi, Haixia Qiu, Desheng Li, Jian Zou, Shaoshan Hu. Fluorescence-guided resection of brain tumor: review of the significance of intraoperative quantification of protoporphyrin IX fluorescence. Neurophotonics 2017; 4 (1): P. 011011.
Neira JA, Ung TH, Sims JS, Malone HR, Chow DS, Samanamud JL, et al. Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance. Journal of Neurosurgery 2017; 127 (1): 111-22.
Hauser SB, Kockro RA, Actor B, Sarnthein J, Bernays RL. Combining 5-aminolevulinic acid fluorescence and intraoperative magnetic resonance imaging in glioblastoma surgery: a histology based evaluation. Neurosurgery 2016; 78: 475-83.
Eljamel MS, Mahboob SO. The effectiveness and cost-effectiveness of intraoperative imaging in high-grade glioma resection; a comparative review of intraoperative ALA, fluorescein, ultrasound and MRI. Photodiagnosis Photodyn Ther. 2016; 16: 35–43.
Louis DN. World Health Organization Histological Classification Classification of Tumours of the Central Nervous System. Lyon, France: International Agency for Research on Cancer. 2016.
Rynda AY, Olyushin VE, Rostovtsev DM. Photodynamic therapy of cerebral glioma – long term survival. Vestnik Rossiiskoi Voenno-Medicinskoi Academii 2017; 2 (58): 68-72.