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

Area of Science:

• Neurosurgery
• Oncology
• Medical Imaging

Background:

• 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery offers superior high-grade glioma resection compared to conventional methods.
• Exoscopes, an alternative to traditional microscopes, can be utilized for fluorescence-guided tumor removal.

Purpose of the Study:

• To evaluate the feasibility and efficacy of using an exoscope for 5-ALA fluorescence-guided high-grade glioma resection and neuronavigation-guided biopsies.
• To assess the safety and outcomes of this technique in a consecutive patient cohort.

Main Methods:

• Twenty-three patients with high-grade gliomas underwent surgery using an exoscope with 5-ALA fluorescence guidance.
• Pre- and postoperative volumetric MRI were used to quantify tumor volume in non-biopsy cases.
• Two neuronavigation-guided biopsies were performed.

Main Results:

• Total resection was achieved in 15 patients, with subtotal resection in 5.
• No perioperative mortality was observed.
• Fluorescence intensity varied by tumor type, with glioblastoma multiforme showing high median intensity (4.5/5).

Conclusions:

• An exoscope is a viable and cost-effective tool for 5-ALA fluorescence-guided surgery and neuronavigation-guided biopsy in high-grade glioma patients.
• This approach facilitates collaborative surgery and improves procedural agility.