Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 7/2013

01-07-2013 | Clinical Article - Brain Tumors

Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases

Authors: Francesco Acerbi, Morgan Broggi, Marica Eoli, Elena Anghileri, Lucia Cuppini, Bianca Pollo, Marco Schiariti, Sergio Visintini, Chiara Orsi, Angelo Franzini, Giovanni Broggi, Paolo Ferroli

Published in: Acta Neurochirurgica | Issue 7/2013

Login to get access

Abstract

Background

Fluorescein is widely used as a fluorescent tracer for many applications. Its capability to accumulate in cerebral areas with blood-brain barrier damage makes it an ideal dye for intraoperative visualization of malignant gliomas (MG). We report our preliminary experience in fluorescein-guided removal of grade IV gliomas using a dedicated filter on the surgical microscope.

Methods

In September 2011 we started a prospective phase II trial (FLUOGLIO) to evaluate the safety and obtain initial indications about the efficacy of fluorescein-guided surgery for MG. Patients with suspected MG amenable to complete resection of contrast-enhancing areas were eligible to participate in this study. This report is based on a preliminary analysis of the results of 12 patients with grade IV gliomas out of 15 consecutive cases (age range 48–72 years) enrolled since September 2011.
Fluorescein was injected intravenously (i.v.) after intubation (5–10 mg/kg). The tumor was removed using a microsurgical technique and fluorescence visualization by BLU 400 or YELLOW 560 filters on a Pentero microscope (Carl Zeiss, Germany).
The study was approved by our ethics committee and registered on the European Regulatory Authorities website (EudraCT no. 2011-002527-18).

Results

Histological analysis confirmed grade IV gliomas in 12/15 cases. Median preoperative tumor volume was 33.15 cm3 (9.6–87.8 cm3). No adverse reaction related to the administration of fluorescein was registered. Contrast-enhanced tumor was completely removed in 75 % of the patients.

Conclusion

This preliminary analysis suggested that the use of intravenous fluorescein during surgery on grade IV gliomas is safe and allows a high rate of complete resection of contrast-enhanced tumor at the early postoperative MRI.
Appendix
Available only for authorised users
Literature
1.
Cordella R, Acerbi F, Marras CE, Carozzi C, Vailati D, Saini M, Tringali G, Ferroli P, Dimeco F, Franzini A, Broggi G (2012) Risk of seizures during intraoperative electrocortical stimulation of brain motor areas: a retrospective study on 50 patients. Neurol Sci. doi:10.​1007/​s10072-012-0968-2
2.
Eoli M, Menghi F, Bruzzone MG, De Simone T, Valletta L, Pollo B, Bissola L, Silvani A, Bianchessi D, D’Incerti L, Filippini G, Broggi G, Boiardi A, Finocchiaro G (2007) Methylation of O6-methylguanine DNA methyltransferase and loss of heterozygosity on 19q and/or 17p are overlapping features of secondary glioblastomas with prolonged survival. Clin Cancer Res 13(9):2606–2613PubMedCrossRef
3.
Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, Kros JM, Hainfellner JA, Mason W, Mariani L, Bromberg JE, Hau P, Mirimanoff RO, Cairncross JG, Janzer RC, Stupp R (2005) MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 352(10):997–1003PubMedCrossRef
4.
Koc K, Anik I, Cabuk B, Ceylan S (2008) Fluorescein sodium-guided surgery in glioblastoma multiforme: a prospective evaluation. Br J Neurosurg 22(1):99–103PubMedCrossRef
5.
Kubben PL, ter Meulen KJ, Schijns OE, ter Laak-Poort MP, van Overbeeke JJ, van Santbrink H (2011) Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review. Lancet Oncol 12(11):1062–1070PubMedCrossRef
6.
Kuhnt D, Becker A, Ganslandt O, Bauer M, Buchdelferd M, Nimsky C (2011) Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol 13(12):1339–1348PubMedCrossRef
7.
Kuroiwa T, Kajimoto Y, Ohta T (1998) Development of a fluorescein operative microscope for use during malignant glioma surgery: a technical note and preliminary report. Surg Neurol 50(1):41–49PubMedCrossRef
8.
Kwan AS, Barry C, McAllister IL, Constable I (2006) Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience. Clin Exp Ophthalmol 34(1):33–38CrossRef
9.
Kwiterovich KA, Maguire MG, Murphy RP, Schachat AP, Bressler NM, Bressler SB, Fine SL (1991) Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology 98(7):1139–1142PubMed
10.
Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbush SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95(2):190–198PubMedCrossRef
11.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2007) IARC WHO Classification of tumours of the central nervous system International Agency for Research on Cancer. World Health Organization, Lyon
12.
McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, Weingart JD, Brem H, Quinones-Hinojosa AR (2009) Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 110(1):156–162PubMedCrossRef
13.
Moore GE, Peyton WT, French LA, Walker WW (1948) The clinical use of fluorescein in neurosurgery; the localization of brain tumors. J Neurosurg 5:392–398PubMedCrossRef
14.
Nimsky C, Ganslandt O, Buchfelder M, Fahlbush R (2006) Intraoperative visualization for resection of gliomas: the role of functional neuronavigation and intraoperative 1.5 T MRI. Neurol Res 28(5):482–487PubMedCrossRef
15.
Novtny HR, Alvis DL (1961) A method of photographing fluorescence in circulating blood in the human retina. Circulation 24:82–86CrossRef
16.
17.
Shinoda J, Yano H, Yoshimura S, Okumura A, Kaku Y, Iwama T, Sakai N (2003) Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note. J Neurosurg 99(3):597–603PubMedCrossRef
18.
Stummer W, Meinel T, Ewelt C, Martus P, Jakobs O, Felsber J, Reifenberger G (2012) Prospective cohort study of radiotherapy with concomitant and adjuvant temozolomide chemotherapy for glioblastoma patients with no or minimal residual enhancing tumor load after surgery. J Neurooncol 108(1):89–97PubMedCrossRef
19.
Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ (2000) Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg 93(6):1003–1013PubMedCrossRef
20.
Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7(5):392–401PubMedCrossRef
21.
Stummer W, Stocker S, Novotny A, Heimann A, Sauer O, Kempski O, Plesnila N, Wietzorrek J, Reulen HJ (1998) In vitro and in vivo porphyrin accumulation by C6 glioma cells after exposure to 5-aminolevulinic acid. J Photochem Photobiol B 45(2–3):160–169PubMedCrossRef
22.
Stummer W, Stocker S, Wagner S, Stepp H, Fritsch C, Goetz AE, Kiefmann R, Reulen HJ (1998) Intraoperative detection of malignant gliomas by 5-aminolevulinic acid-induced porphyrin fluorescence. Neurosurgery 42(3):518–526PubMedCrossRef
23.
Stupp R, Hegi ME, Mason WP, van dern Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Villa S, Eisenhauer E, Gorlia T, Weller M, Lacombe D, Cairncross JG, Mirimanoff RO (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10(5):459–466PubMedCrossRef
24.
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant Temozolomide for glioblastoma. N Engl J Med 352(10):987–996PubMedCrossRef
25.
Tonn JC, Stummer W (2008) Fluorescence-guided resection of malignant gliomas using 5-aminolevulinic acid: practical use, risks, and pitfalls. Clin Neurosurg 55:20–26PubMed
26.
Unsgaard G, Ommedal S, Muller T, Gronningsaeter A, Nagelhus Hernes TA (2002) Neuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resection. Neurosurgery 50(4):804–812PubMedCrossRef
27.
Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28(11):1963–1972PubMedCrossRef
28.
Wirtz CR, Albert FK, Schwaderer M, Heuer C, Staubert A, Tronnier VM, Knauth M, Kunze S (2000) The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery. Neurol Res 22(4):354–360PubMed
29.
Yannuzzi LA, Rohrer KT, Tindel LJ, Sobel RS, Costanza MA, Shields W, Zang E (1986) Fluorescein angiography complication survey. Ophthalmology 93(5):611–617PubMed
Metadata
Title
Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases
Authors
Francesco Acerbi
Morgan Broggi
Marica Eoli
Elena Anghileri
Lucia Cuppini
Bianca Pollo
Marco Schiariti
Sergio Visintini
Chiara Orsi
Angelo Franzini
Giovanni Broggi
Paolo Ferroli
Publication date
01-07-2013
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 7/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-013-1734-9

Other articles of this Issue 7/2013

Acta Neurochirurgica 7/2013 Go to the issue

Experimental Research - Brain Injury

The efficacy and safety of chitosan dextran gel in a burr hole neurosurgical sheep model

Clinical Article - Spine

Syndromic versus nonsyndromic atlantoaxial dislocation: do clinico-radiological differences have a bearing on management?

Clinical Article - Spine

Clinical outcomes of conservative management of spinal cord cavernous angiomas

Clinical Article - Brain Tumors

Outcomes after surgery for central neurocytoma: results of a French multicentre retrospective study

Clinical Article - Spine

Comparative effectiveness of PEEK rods versus titanium alloy rods in lumbar fusion: A preliminary report

Technical Note - Neurosurgical Techniques

Intraoperative fluorescence for resection of hemangioblastomas