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Resection of intra- and paraventricular malignant brain tumors using fluorescein sodium-guided neuroendoscopic
Murat Kutlay1, Mehmet Ozan Durmaz1, Alparslan Kırık1
1Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey.
Background:
The requirement of brain retraction and difficulty in distinguishing the tumor demarcation are challenging in conventional approaches to intra- and paraventricular malignant tumors (IV-PVMTs). Tubular retractors can minimize the retraction injury, and fluorescein-guided (FG) surgery may promote the resection of tumors. Our aim is to evaluate the feasibility, safety, and effectiveness of fluorescein-guided endoscopic transtubular surgery for the resection of IV-PVMTs.
Methods:
Twenty patients with IV-PVMTs underwent FG endoscopic transtubular tumor resection. Fluorescein sodium was administered before the dural opening. The intraoperative fluorescence staining was classified as "helpful" and "unhelpful" based on surgical observation. Extent of resection was assessed using postoperative magnetic resonance imaging. Karnofsky Performance Status (KPS) score was used to evaluate the general physical condition of patients.
Results:
There were 9 glioblastomas, 4 anaplastic astrocytomas and 7 metastatic tumors. "Helpful" fluorescence staining was observed in 16(80%) of 20 patients. Gross total resection was achieved in 16(80%) cases, near-total in 3(15%) cases, and subtotal in 1 (5%) case. No intra- or postoperative complications related to the fluorescein sodium occurred. The median preoperative KPS score was 83, and the median KPS score 3-month after surgery was 88.
Conclusion:
FG endoscopic transtubular surgery is a feasible technique for the resection of IV-PVMTs. It may be a safe and effective option for patients with these tumors. Future prospective randomized studies with larger samples are needed to confirm these preliminary data.
Insights
Fluorescein-guided endoscopic transtubular surgery offers a safe and effective approach for removing intra- and paraventricular malignant tumors (IV-PVMTs), minimizing brain retraction injury. This technique demonstrated high rates of gross total resection in a pilot study.
Area of Science:
- Neurosurgery
- Oncology
- Surgical Technology
Background:
- Conventional surgery for intra- and paraventricular malignant tumors (IV-PVMTs) faces challenges with brain retraction and tumor demarcation.
- Tubular retractors and fluorescein-guided (FG) surgery show promise in mitigating these challenges.
Purpose of the Study:
- To evaluate the feasibility, safety, and effectiveness of fluorescein-guided endoscopic transtubular surgery for IV-PVMT resection.
Main Methods:
- Twenty patients with IV-PVMTs underwent FG endoscopic transtubular tumor resection.
- Fluorescein sodium was administered, and intraoperative fluorescence was assessed.
- Resection extent and patient outcomes (Karnofsky Performance Status) were evaluated.
Main Results:
- Fluorescence guidance was helpful in 80% of cases.
- Gross total resection was achieved in 80% of patients.
- No complications related to fluorescein sodium were observed, and patient KPS scores improved post-surgery.
Conclusions:
- Fluorescein-guided endoscopic transtubular surgery is a feasible, safe, and effective option for IV-PVMT resection.
- Further prospective studies are warranted to confirm these findings.
