"Dark corridors" in 5-ALA resection of high-grade gliomas: combining fluorescence-guided surgery and contrast-enhanced ultrasonography to better explore the surgical field

2020 ◽  
Vol 63 (6) ◽  
Author(s):  
Giuseppe M. Della Pepa ◽  
Tamara Ius ◽  
Grazia Menna ◽  
Giuseppe La Rocca ◽  
Claudio Battistella ◽  
...  
Keyword(s):  
High Grade ◽  
Guided Surgery ◽  
Contrast Enhanced ◽  
Fluorescence Guided Surgery ◽  
Contrast Enhanced Ultrasonography ◽  
Surgical Field ◽  
High Grade Gliomas

scholarly journals NIMG-12. MULTICOLOURED-ASSISTED SURGERY FOR RESECTION OF HIGH GRADE GLIOMAS WITH 5-AMINOLEVULINACID

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi164-vi164
Author(s):  
Cleopatra Charalampaki ◽  
Dimitrios Atanasopoulos
Keyword(s):  
Real Time ◽  
White Light ◽  
High Grade ◽  
Field Orientation ◽  
Additional Information ◽  
Guided Surgery ◽  
Surgical Microscope ◽  
Fluorescence Guided Surgery ◽  
Surgical Field ◽  
High Grade Gliomas

Abstract INTRODUCTION Fluorescence guided surgery with the use of 5-aminolevulinacid (5 -ALA) is nowadays the state of the art treatment of high grade gliomas. However, intraoperative visualization of 5-ALA under dark blue light remains challenging, especially when leaking blood covers parts of the surgical field, where tumor fluorescence becomes invisible. To overcome this problem and combine the brightness of visible light with the information delivered by fluorescence we developed multispectral fluorescence, a technique able to project both information in real time to the surgeon’s eyes, and embedded it on a surgical microscope. METHODS We examined 40 patients with brain tumors who underwent surgery, using the MFL operative technique. The tumors involved comprised of 20 glioblastomas, 7 astrocytomas WHO III, 5 meningiomas and 8 metastatic tumors. The MFL technique with the real-time overlay of 5-ALA fluorescence and white light was intraoperatively compared to the classic blue filter detecting 5-ALA fluorescence. RESULTS The tumor was in all cases clearly visible and highlighted from the surrounding tissues. The pseudocolor we chose to visualize the tumor was green, representing 5-ALA fluorescence, with the surrounding brain tissueremained in its origin white color. In the cases where blood was covering the surgical field, orientation was easy to maintain, due to the additional information delivered from the white light image. CONCLUSIONS The MFL technique embedded on a surgical microscope opens the way for a precise and clear visualization of tumor 5-ALA fluorescence in real time under white light. It can be easily implemented in the resection of all tumors accumulating 5-ALA. Drawbacks of classic 5-ALA fluorescence such as hidden fluorescence because of overlying blood could be overcome with the presence of additional white light and the clear visualization of the exposed brain.

scholarly journals 5-Aminolevulinic Acid–Protoporphyrin IX Fluorescence-Guided Surgery for CNS Tumors

2018 ◽  
Vol 27 (1) ◽  
pp. 13-19
Author(s):  
Ricardo Ramina ◽  
Erasmo Barros Da Silva Júnior ◽  
Maurício Coelho Neto ◽  
Leonardo Gilmone Ruschel ◽  
Felipe Andrés Constanzo Navarrette
Keyword(s):  
Aminolevulinic Acid ◽  
Protoporphyrin Ix ◽  
High Grade Glioma ◽  
Awake Surgery ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
High Grade ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
High Grade Gliomas

Introduction: In the last two decades the 5-aminolevulinic acid (5-ALA) has been utilized in primary brain lesions and metastases surgery to aid the identification of tumor limits and infiltration. Objectives: In this retrospective study, we demonstrate our experience with the first 41 cases Latin America of surgical resection of central nervous system (CNS) lesions with 5-ALA. Methods: In 41 consecutive patients, we recorded age, sex, histopathological diagnosis, intraoperative 5-ALA fluorescence tumor response, 5-ALA post-resection resection grade through magnetic resonance image (MRI) and other concomitantintra-operative techniques utilized (transoperative imaging, awake surgery, electrophysiological stimulation and monitoring). Results: Twenty seven high-grade gliomas and 4 non-glial lesions were 5-ALA fluorescence positive; 6 low-grade gliomas, 1 high-grade glioma and a hippocampal gliosis were 5-ALA fluorescence negative. In one case of a low-grade glioma, the patient developed a cardiac arrhythmia, probably not related to 5-ALA administration, but the surgery was suspended. Conclusions: 5-ALA fluorescence-guided surgery is a safe and easy technique to be used, increasing tumor total gross resection in glioma cases, proving to be an invaluable neurosurgical tool for intracranial tumor surgery. There was no serious side effect in this series. This dye should be utilized in all cases of high-grade gliomas. 

Fluorescence-guided surgery for high-grade gliomas

2018 ◽  
Vol 118 (2) ◽  
pp. 356-361 ◽  
Author(s):  
Nikita Lakomkin ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
High Grade ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
High Grade Gliomas

Ultrasound-based real-time neuronavigated fluorescence-guided surgery for high-grade gliomas: technical note and preliminary experience

2019 ◽  
Vol 161 (12) ◽  
pp. 2595-2605
Author(s):  
Alessandro Villa ◽  
Gabriele Costantino ◽  
Francesco Meli ◽  
Antonino Odierna Contino ◽  
Alessia Imperato ◽  
...  
Keyword(s):  
Real Time ◽  
Technical Note ◽  
High Grade ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
High Grade Gliomas

Fluorescence-guided surgery in high grade gliomas using an exoscope system

2014 ◽  
Vol 156 (4) ◽  
pp. 653-660 ◽  
Author(s):  
José Piquer Belloch ◽  
Vicente Rovira ◽  
Jose L. Llácer ◽  
Pedro A. Riesgo ◽  
Antonio Cremades
Keyword(s):  
High Grade ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
High Grade Gliomas

scholarly journals Qualitative head-to-head comparison of headlamp and microscope for visualizing 5-ALA fluorescence during resection of glioblastoma

2022 ◽  
Vol 6 (1) ◽  
pp. V7
Keyword(s):  
Aminolevulinic Acid ◽  
Standard Of Care ◽  
High Grade ◽  
Operative Field ◽  
Guided Surgery ◽  
Link Type ◽  
Fluorescence Guided Surgery ◽  
Similar Images ◽  
High Grade Gliomas

Fluorescence-guided surgery (FGS) for high-grade gliomas using 5-aminolevulinic acid has become a new standard of care for neurosurgeons in several countries. In this video the authors present the case of a man with glioblastoma who underwent FGS in which similar images of the operative field were acquired alternating between the microscope and a new commercially available headlight, facilitating the comparison of visualization quality between the two devices. The authors also review some of the principles of fluorescence-guidance surgery that may explain the improved brightness and contrast that they observed when using the headlamp versus the microscope. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21181

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