Development of a fluorescein operative microscope for use during malignant glioma surgery - A technical note and preliminary report
Development of a fluorescein operative microscope for use during malignant glioma surgery - A technical note and preliminary report
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DOI：
10.1016/s0090-3019(98)00055-x
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发表时间：
1998-07-01
影响因子：
--
通讯作者：
Ohta, T
中科院分区：
文献类型：
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作者：
Kuroiwa, T;Kajimoto, Y;Ohta, T
背景。荧光素已被应用于神经外科领域；然而，由于缺乏适当的光源或滤光片，荧光素增强或对比度证明是不够的。本文报道了一种新型的手术显微镜系统，该系统本身装有激发和屏障滤光片，并在恶性胶质瘤手术中的应用。手术显微镜采用EP 450-490玻璃干涉滤光片作为光源光学系统的激发滤光片，柯达Wratten No. 12滤光片作为显微镜光学系统的阻隔滤光片。设计了一种开关装置，以便在观察荧光时立即插入滤光片。本研究选择了10例通过计算机断层扫描（CT）或磁共振成像（MRI）增强恶性胶质瘤位置的病例。切开硬脑膜后，静脉注射荧光素Na 8 mg/Kg体重。在新开发的荧光素手术显微镜系统的帮助下，注射后约20分钟开始肿瘤切除。使用该系统时，荧光增强和对比度显著。它可以在观察物体的荧光图像时进行手术操作。在荧光图像上，CT或MRI增强的肿瘤区域与周围脑区边界清晰；除深部病变外，肿瘤完全切除，神经系统无任何恶化。当肿瘤较硬时，用空腔超声手术吸引器对肿瘤周围区域进行吸痰；因此，肿瘤可以整体切除；否则逐片切除荧光肿瘤。该系统提供足够的荧光增强和对比，是有用的观察手术期间静脉注射荧光素。虽然此类病例需要长期随访，但我们的恶性胶质瘤患者术后立即情况令人满意。这些结果表明我们的荧光素手术显微镜系统在恶性胶质瘤的手术中是非常有效的。(C) 1998年Elsevier Science Inc。
BACKGROUND. Fluorescein has been used in the field of neurosurgery; however, fluorescein enhancement or contrast proved to be inadequate because of a lack of appropriate light sources or filters. A new operative microscope system, in which the microscope itself is equipped with excitation and barrier filters, and the application of this system to surgery for malignant glioma are reported.METHODS. EP 450-490, a glass interference filter used as the excitation filter for the light source optical system, and a Kodak Wratten No. 12 filter used as the barrier filter for the microscope optical system, were incorporated in the operative microscope. A switching apparatus was devised so that filters could be inserted instantly when fluorescence was to be observed. Ten cases in which the location of malignant glioma was enhanced by computed tomography (CT) or magnetic resonance imaging (MRI) were selected for this study. After incision of the dura mater, 8 mg/Kg body weight of fluorescein Na was injected intravenously. Tumor removal was begun some 20 min after the injection with the aid of this newly developed fluorescein operative microscope system.RESULTS. Fluorescence enhancement and contrast were remarkable when this system was used. It enabled surgical maneuvering while viewing the fluorescent image of objects. The boundaries between the tumor areas enhanced by CT or MRI and the surrounding brain could be clearly distinguished in the fluorescent image; the tumor was totally removed, except for deep lesions, without any neurological deterioration. When the tumor was relatively hard, the area surrounding the tumor was aspirated with a cavitron ultrasonic surgical aspirator; as a result, the tumor could be removed en bloc; otherwise, the fluorescent tumor was removed piece by piece.CONCLUSIONS. This system provides adequate fluorescent enhancement and contrast and is useful for observing intravenously injected fluorescein during an operation. Though longterm follow-up of such cases is needed, the conditions of our patients immediately after surgery for malignant glioma were satisfactory. These results suggest that our fluorescein operative microscope system is highly effective in surgery for malignant glioma. (C) 1998 by Elsevier Science Inc.