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Optimization of novel exoscopic blue light filter during fluorescence-guided resection of Glioblastoma
Andrew J Witten1, Netanel Ben-Shalom2, Jason A Ellis2
1Department of Neurological Surgery, Indiana University, Indianapolis, IN, 46202, USA.
Purpose:
Operative guidelines and use optimization for new surgical exoscopes are not well described in the literature. In this study, we evaluated use of the ORBEYE (Olympus) surgical exoscope system during 5-ALA fluorescence-guided resection of GBMs to optimize workflow and exoscope settings.
Methods:
The ORBEYE exoscope system was fitted with a blue light filter for 5-ALA mediated fluorescence-guided surgery (FGS). Intraoperative images were obtained during 5-ALA FGS in 9 patients with primary or recurrent GBM. The exoscope was set up at constant, increasing focal distances from the target tissue, and light source intensity varied. High-resolution 4 K images were captured and analyzed. Comparisons of fluorescence to background were then generated for use optimization.
Results:
Light intensity did not significantly influence tumor fluorescence (P = 0.878). However, focal distance significantly impacted relative fluorescent intensity (P = 0.007). Maximum average fluorescence was seen consistently at a focal length of 220 mm and a light intensity of approximately 75% maximum. Decreasing focal distance from 400 mm to 220 mm significantly increased visualized fluorescence (P = 0.0038).
Conclusions:
The ORBEYE surgical exoscope system with blue light filter is a powerful imaging tool for 5-ALA FGS in GBM. The ORBEYE blue filter performs optimally at shorter focal distance with moderate light intensity. Similar to microscope systems, decreasing focal distance significantly influences visualized fluorescence.
Insights
Optimizing the ORBEYE surgical exoscope for 5-ALA fluorescence-guided surgery in glioblastoma resection showed that shorter focal distances significantly enhance visualized tumor fluorescence. Moderate light intensity is recommended for best results.
Area of Science:
- Neurosurgery
- Surgical Technology
- Oncology
Background:
- Surgical exoscopes offer advanced visualization but lack standardized operative guidelines.
- Optimizing settings for new systems like the ORBEYE is crucial for effective use.
- 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery (FGS) aids in differentiating tumor tissue.
Purpose of the Study:
- To evaluate the ORBEYE surgical exoscope system for optimizing workflow and settings during 5-ALA FGS in glioblastoma (GBM) resection.
- To establish operative guidelines for the ORBEYE exoscope in neurosurgical oncology.
- To determine optimal exoscope parameters for enhanced visualization of GBM during surgery.
Main Methods:
- The ORBEYE exoscope was configured with a blue light filter for 5-ALA FGS.
- High-resolution 4K images were captured in 9 patients undergoing GBM resection.
- Exoscope focal distance and light intensity were systematically varied to assess their impact on fluorescence visualization.
Main Results:
- Light intensity did not significantly affect tumor fluorescence (P=0.878).
- Focal distance significantly impacted relative fluorescent intensity (P=0.007).
- Optimal fluorescence was observed at a focal distance of 220 mm and 75% light intensity, with shorter distances increasing visualization.
Conclusions:
- The ORBEYE surgical exoscope with a blue light filter is effective for 5-ALA FGS in GBM.
- Optimal performance is achieved at shorter focal distances and moderate light intensity.
- Decreasing focal distance enhances visualized fluorescence, similar to microscope systems.
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