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Fluorescein-Guided Surgery for Malignant Gliomas.

Marcos Dellaretti1, Matheus Tavares de Melo2, Franklin Bernardes Faraj de Lima2

  • 1Neurosurgery Department, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

World Neurosurgery
|March 11, 2023
PubMed
Summary

Fluorescein (FS) safely enhances visualization of malignant gliomas during surgery. This technique, using a specialized microscope filter, aids in complete tumor resection with reduced FS dosage.

Keywords:
Augmented reality surgeryFluoresceinFluorescein-guided surgeryGlioblastomaHigh-grade gliomaMalignant gliomaMicrosurgery

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Area of Science:

  • Neurosurgery
  • Oncology
  • Medical Imaging

Background:

  • Fluorescein (FS) has been used for malignant brain tumor visualization since 1948.
  • FS accumulates in malignant gliomas due to blood-brain barrier disruption, mirroring gadolinium enhancement on preoperative MRI.
  • It offers intraoperative visualization of tumor margins.

Observation:

  • FS is excited by 460-500 nm light and emits green fluorescence at 540-690 nm.
  • Using a YELLOW 560 nm filter with an operating microscope significantly reduces the required FS dose.
  • The fluorescein-guided technique was employed in a case of a left temporal polar tumor removal.

Findings:

  • The fluorescein-guided technique clearly discriminated between brain and tumor tissue, appearing bright yellow.
  • The method is safe and facilitates complete resection of high-grade gliomas.
  • This approach allows for precise tumor removal using standard microneurosurgical techniques with alternating white light and filtered illumination.

Implications:

  • Fluorescein-guided surgery offers a cost-effective and safe method for improving high-grade glioma resection rates.
  • Reduced FS dosage with dedicated filters enhances safety and potentially lowers costs.
  • This technique represents a valuable adjunct for neurosurgeons aiming for maximal safe tumor removal.