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Published on: July 16, 2018
Radioguided surgery using gamma detection probe technology for resection of cerebral glioma
Afsoun Seddighi1, Mohammad Esmail Akbari, Amir Saied Seddighi
1Department of Neurosurgery, Shohada Tajrish Hospital, Tajrish Sq, Tehran, Iran. a_sedighi@sbmu.ac.ir.
Objective:
Using microsurgical procedures without intraoperative imaging, Gross Total Resection (GTR) has so far only been achieved in less than 30% of all cases. Radio-guided surgery was introduced in the clinical setting in 1985 in an attempt to facilitate intraoperative tumor detection. Because of few studies in literature about this subject, we decided to use gamma probe with the hypothesis that we could increase extent of tumor resection.
Materials And Methods:
From January 2013 till February 2014, 22 patients with cerebral glioma were randomized equally into two groups and evaluated. In the first group, 370MBq of Technetiumc-99m was injected. The microsurgical resection of the tumor was performed as much as possible, and then the tumoral bed was examined, if the signal was more than 2 times of the background signal, more tissue resection performed if feasible until the signal was diminished. In the control group, conventional resection of the tumor was performed. The extent of tumor resection was assessed by contrast magnetic resonance imaging (MRI) study.
Results:
Before surgery the patients in the first group had average tumor volume of 81.68±9.78. In the second group the average tumor volume before surgery was 82.63±10.06cc. There is no significant difference between preoperative tumor volumes in two groups. In the first group, in the post-operative MRI, the tumor volume was 5.04±2.69cc and in the second group it was 9.5±4.8cc. Eight patients (72.7%) in the radioguided group experienced radical resection (more than 95%), but in the control group radical resection was achieved in just 3 patients (27.2%), radical resection was significantly higher in radioguided group (P<0.001). Due to the usage of the gamma detection probe, time of finding the tumor in the radioguided group was significantly less than control group (P=0.02). However total operation time in the radioguided group, was not significantly more than the control group (P=0.88).
Conclusions:
Neuronavigation system increases the percentage of gross total resection, but it is expensive, increases duration of surgery is not considered a real-time assessment, and is not accurate in determining the borders of glioma due to brain shift. In contrast, radio-guided surgery is easy to use, real time, not expensive, and increases the extent of tumor resection.
Insights
Radio-guided surgery significantly increases the extent of glioma resection compared to conventional methods. This technique aids in intraoperative tumor detection, improving radical resection rates and reducing residual tumor volume.
Area of Science:
- Neurosurgery
- Oncology
- Nuclear Medicine
Background:
- Gross Total Resection (GTR) rates for cerebral gliomas without intraoperative imaging are below 30%.
- Radio-guided surgery, introduced in 1985, aims to improve intraoperative tumor detection.
- Limited studies necessitate further investigation into radio-guided surgery's efficacy.
Purpose of the Study:
- To evaluate the effectiveness of a gamma probe in enhancing the extent of tumor resection in cerebral glioma patients.
- To hypothesize that radio-guided surgery can increase the rate of Gross Total Resection (GTR).
Main Methods:
- A randomized study of 22 cerebral glioma patients comparing radio-guided surgery with conventional resection.
- Radio-guided group received Technetium-99m, with resection guided by a gamma probe detecting signals >2x background.
- Control group underwent conventional microsurgical resection; extent assessed by post-operative MRI.
Main Results:
- Radio-guided surgery achieved radical resection ( >95%) in 72.7% of patients, versus 27.2% in the control group (P<0.001).
- Post-operative tumor volume was significantly lower in the radio-guided group (5.04±2.69cc) compared to the control group (9.5±4.8cc).
- Tumor detection time was reduced in the radio-guided group (P=0.02), with no significant increase in overall operation time (P=0.88).
Conclusions:
- Radio-guided surgery is a cost-effective, real-time method that significantly increases the extent of glioma resection.
- It offers advantages over neuronavigation systems, which are expensive and less accurate due to brain shift.
- This technique facilitates improved intraoperative tumor localization and resection completeness.
