Resection of intra- and paraventricular malignant brain tumors using fluorescein sodium-guided neuroendoscopic transtubular approach.

Autor: Kutlay M; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Durmaz MO; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Kırık A; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Yasar S; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Ezgu MC; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Kural C; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Temiz C; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Tehli O; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Daneyemez M; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Izci Y; Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey. Electronic address: yusuf.izci@sbu.edu.tr.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2021 Aug; Vol. 207, pp. 106812. Date of Electronic Publication: 2021 Jul 10.
DOI: 10.1016/j.clineuro.2021.106812
Abstrakt: 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.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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