Technical principles for protoporphyrin-IX-fluorescence guided microsurgical resection of malignant glioma tissue
Technical principles for protoporphyrin-IX-fluorescence guided microsurgical resection of malignant glioma tissue
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DOI：
10.1007/s007010050206
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发表时间：
1998-01-01
影响因子：
2.4
通讯作者：
Reulen, HJ
中科院分区：
文献类型：
--
作者：
Stummer, W;Stepp, H;Reulen, HJ
恶性胶质瘤暴露于5-氨基乙酰丙酸(一种血红素的代谢前体)后，细胞内聚集有荧光原卟啉IX。这一现象已被用于术中识别残留肿瘤，以实现更完整的肿瘤切除。本报告描述了对手术显微镜的必要改进，以实现显微手术、荧光引导的肿瘤切除。该系统由耦合到显微镜的氙气光源组成，可以从正常的白光切换到紫蓝色激发光(375-440 nm)。在观察者光路中引入长通滤光片，以观察肿瘤的荧光。选择激励滤光片和观察滤光片的传输特性来传输部分发射的激发光。因此，观察者保留了组织细节的印象，旁边是肿瘤的卟啉荧光。针对红光检测优化的集成三芯片CCD摄像机能够记录荧光发现。目前的改进允许在不中断手术过程的情况下，简单而快速地识别红色肿瘤荧光及其与正常组织的边界。组织细节足够大，可以在部分手术过程中在紫蓝色激发光下进行肿瘤切除。该系统似乎构成了一种有用的工具，用于在常规基础上优化恶性胶质瘤的切除。
Malignant gliomas accumulate fluorescing protoporphyrin IX intracellularly after exposure to 5-aminolevulinic acid, a metabolic precursor of haem. This phenomenon has been exploited for intraoperative identification of residual tumour to enable greater completeness of tumour removal. The present report describes the necessary modifications to the operating microscope to enable microsurgical, fluorescence-guided tumour removal.The system consists of a xenon light source coupled to the microscope, which can be switched from normal white light to violet-blue excitation light (375-440 nm). A longpass filter is introduced into the observer light path to enable observation of tumour fluorescence. Transmission characteristics of excitation and observation filters are chosen to transmit part of the remitted excitation light. Thereby the observer retains an impression of tissue detail, next to tumour porphyrin fluorescence. An integrating three chip CCD camera optimized for red light detection enables documentation of fluorescence findings.The present modifications allow uncomplicated and rapid recognition of red tumour fluorescence and its borders to normal tissue, without interrupting the course of the operation. Tissue detail is great enough to enable tumour resection under violet-blue excitation light during parts of the operation. The system appears to constitute a useful tool for optimizing removal of malignant gliomas on a routine basis.