Fluorescence and image guided resection in high grade glioma

The extent of resection in high grade glioma is increasingly been shown to positively effect survival. Nevertheless, heterogeneity and migratory behavior of glioma cells make gross total resection very challenging. Several techniques were used in order to improve the detection of residual tumor. Aim of this study was to analyze advantages and limitations of fluorescence and image guided resection. A multicentric prospective study was designed to evaluate the accuracy of each method. Furthermore, the role of 5-aminolevulinc acid and neuronavigation were reviewed.Twenty-three patients harboring suspected high grade glioma, amenable to complete resection, were enrolled. Fluorescence and image guides were used to perform surgery. Multiple samples were obtained from the resection cavity of each lesion according to 5-ALA staining positivity and boundaries as delineated by neuronavigation. All samples were analyzed by a pathologist blinded to the intra-operative labeling. Decision-making based on fluorescence showed a sensitivity of 91.1% and a specificity of 89.4% (p < 0.001). On the other hand, the image-guided resection accuracy was low (sensitivity: 57.8%; specificity: 57.4%; p = 0.346). We observed that the sensitivity of 5-ALA can be improved by the combined use of neuronavigation, but this leads to a significant reduction in specificity. Thus, the use of auxiliary techniques should always be subject to critical skills of the surgeon. We advocate a large-scale study to further improve the assessment of multimodal approaches.     

5-氨基乙酰丙酸荧光引导显微手术切除人脑胶质瘤

目的探讨临床应用荧光物质引导的显微手术切除人脑胶质瘤的要点,评估该技术的安全性及疗效。方法2006年4月至2006年10月术前经CT或MRI证实胶质瘤的11例病人接受了荧光引导胶质瘤手术。男5例,女6例。年龄35～66岁,平均48．5岁。术前应用5-氨基乙酰丙酸（5-ALA）,术中根据所提供的荧光影像判定肿瘤边界并切除肿瘤。根据不同荧光强度取材进行HE染色以检测手术切除情况。术后行MRI检查以确定肿瘤的切除情况。结果胶质瘤在荧光光源的照射下被激发出红色荧光,而正常脑组织不发光。荧光强度高的肿瘤组织HE染色显示含有大量的肿瘤细胞,并可见血管内皮细胞增生,荧光强度较弱或者没有荧光的区域仅有少量的肿瘤细胞和血管内皮细胞增生。病人术后的MRI检查证实肿瘤切除比较完全。结论该方法能够有效的切除胶质瘤,并为手术者提供客观的肿瘤边界,提高了手术切除率。对该方法的确切评估尚需对手术病人进行长期随访。     

恶性胶质瘤外照射加X刀推量治疗模式的探讨

目的恶性胶质瘤是预后极差的常见颅内恶性肿瘤，本研究报告恶性胶质瘤外照射加X刀推量的治疗模式的疗效。方法对15例确诊为恶性胶质瘤的患者进行了外照射加X刀推量的治疗。外照射50Gy／25F／5W后，紧接着用X刀推量7～10Gy。结果治疗后近期效果满意，无严重神经功能障碍并发症。3例患者分别死于X刀后4、5、11月，余均健在。全组仅1例在治疗后3月出现脑水肿，给予对症治疗后缓解。余患者无严重的放射反应。结论恶性胶质瘤外照射加X刀推量的治疗模式是可行的．疗效较好。