Surgery of high-grade gliomas guided by fluorescence: A retrospective study of 22 patients
Surgery of high-grade gliomas guided by fluorescence: A retrospective study of 22 patients
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DOI：
10.1016/j.neuchi.2012.07.002
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发表时间：
2013-02-01
期刊：
影响因子：
1.6
通讯作者：
Guyotat, J.
中科院分区：
文献类型：
--
作者：
Jacquesson, T.;Ducray, F.;Guyotat, J.
背景和目的。- 最佳手术切除可改善胶质母细胞瘤的预后。然而，由于其侵入性，这一目标远未实现。几项研究已经显示了荧光引导手术在提高胶质母细胞瘤切除质量方面的疗效。我们在此报告我们的经验，通过回顾性系列和描述的原则，限制和优势，这项技术。- 在2006年至2009年期间，22名患者接受了荧光引导的胶质母细胞瘤切除术。手术后，所有患者均接受了连续的临床检查和放射学监测，使用多模式MRI。手术过程中由外科医生和放射科医生在MRI上评估切除程度。分析无进展临床生存期（SSP）和总生存期（SG）曲线。研究了切除范围的预后价值。- 根据外科医生评估的无残留荧光，我们获得了68.2%的完全切除，根据早期MRI上无残留肿瘤，我们获得了75%的完全切除。中位SSP为10.75个月，中位SG为17个月。通过荧光消失证实的肿瘤完全切除显著增加了中位SSP（6.7个月至12.9个月）（p = 0.001559）和中位SG（12.3个月至20.9个月）（p = 0.000559）。1年后，81.8%的患者仍然存活。- 我们的研究证实了使用荧光作为一种有效的方法，允许胶质母细胞瘤的最佳切除。除了神经导航、手术经验、视觉和本体感觉，荧光有助于实现完整的肿瘤切除。(C)2012年Elsevier Masson SAS。All rights reserved.
Background and purpose. - Optimal surgical resection improves the prognosis of glioblastomas. However, this goal is far from being achieved due to its invasive nature. Several studies have already shown the efficacy of fluorescence-guided surgery, in improving the quality of resection of glioblastoma. We report herein our experience through a retrospective serie and describe the principles, limitations and advantages of this technique.Methods. - Between 2006 and 2009, 22 patients underwent resection of a glioblastoma guided by fluorescence. Following operations, all patients underwent sequential clinical examination and radiological monitoring using multimodal MRI. The extent of resection was assessed by the surgeon during the procedure and by the radiologist on MRI. The curves of progression-free clinical survival (SSP) and overall survival (SG) were analyzed. The prognostic value of the extent of resection was studied.Results. - We obtained 68.2% of complete resection according to the absence of residual fluorescence as assessed by the surgeon, and 75% according to the absence of residual tumor on early MRI. The median SSP was 10.75 months and the median SG was 17 months. Complete tumoral resection confirmed by loss of fluorescence significatively increases the median SSP of 6.7 months to 12.9 months (p = 0.001559) and the median SG of 12.3 months to 20.9 months (p = 0.000559). After 1 year, 81.8% of patients were still alive.Conclusions. - Our study confirms the use of fluorescence as an effective method to allow optimal resection of glioblastoma. In addition to neuronavigation, surgical experience, vision and proprioception, fluorescence contributes to achieve a complete tumor resection. (C) 2012 Elsevier Masson SAS. All rights reserved.