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

  • Technical Note - Brain Tumors
  • Published:
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Abstract

Background

The extent of resection (EOR) plays a fundamental role in the prognosis of patients with high-grade gliomas (HGG). One of the main challenges in achieving a complete resection is the distinction between tumor and normal brain. Nowadays, several technologies are employed to obtain a higher tumor removal rate and respect the normal tissue in glioma surgery and in the last decades, fluorescein sodium (FS) and intraoperative ultrasound (IOUS) have been widely used. The aim of our technical note is to demonstrate how combining these two tools offers an ultrasound-based real-time neuronavigated fluorescence-guided surgery in order to optimize HGG removal.

Methods

Five patients (3 males, 2 females; mean age 55.2 years, range 36–68 years) undergoing craniotomies for removal of intraaxial lesions suggestive of high-grade gliomas on preoperative MRI were included in the study. Intraoperative navigated B-mode and CEUS associated with sodium fluorescein were used in all cases; white light appearance, IOUS, and fluorescence findings were recorded immediately after each surgery. Also, extent of resection was evaluated on postoperative Gd-enhanced MRI performed within 72 h.

Results

All tumors effectively stained yellow with fluorescein sodium during the surgical procedure and four were well delineated by IOUS. IOUS was repeated frequently (average 2.6 time) to obtain an orientation of the gross residual tumor with respect to anatomical landmarks as the surgery proceeded. Tumor removal was completed under Yellow 560 filter.

Conclusions

In our technical report, we demonstrate that combining intraoperatively fluorescein sodium and IOUS improves the information and facilitates making decisions during the HGG surgery. Further experience gained in larger studies will help confirm these findings

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Authors and Affiliations

  1. Division of Neurosurgery, ARNAS Civico Hospital, Piazza Nicola Leotta 4, 90127, Palermo, Italy

    Alessandro Villa, Gabriele Costantino, Francesco Meli, Antonino Odierna Contino & Natale Francaviglia

  2. Division of Neurosurgery, AORN Santobono Pausilipon, Naples, Italy

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  1. Alessandro Villa
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  2. Gabriele Costantino
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  3. Francesco Meli
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  5. Alessia Imperato
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  6. Natale Francaviglia
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Correspondence to Alessandro Villa.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the ARNAS Civico Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All patients included in the study were informed about the surgical procedure and in all cases, written consent was obtained.

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This article is part of the Topical Collection on Brain Tumors

Alessandro Villa and Gabriele Costantino are co-first authors.

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Villa, A., Costantino, G., Meli, F. et al. Ultrasound-based real-time neuronavigated fluorescence-guided surgery for high-grade gliomas: technical note and preliminary experience. Acta Neurochir 161, 2595–2605 (2019). https://doi.org/10.1007/s00701-019-04094-x

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