PDF(Pubmed)
Abstract：
UNASSIGNED: Awake craniotomy (AC) maximizes the resection of lesions in eloquent brain areas while preserving functionality. Tumor delineation with intraoperative use of sodium fluorescein (NaFl) facilitates total resection. When used with AC, it may allow for safe resection without increasing the risk of postoperative neurologic deficits. This study investigated the efficacy and safety of the combined use of NaFl and AC for maximum safe resection in patients with brain metastases.
UNASSIGNED: Patients who underwent AC due to brain metastasis in the Department of Neurosurgery of Uludağ University\'s Faculty of Medicine between January 1, 2018 and August 1, 2022, were retrospectively analyzed. The study comprised 2 patient groups: plain AC (pAC) and NaFl-guided AC (NaFlg-AC). Surgical outcomes related to fluorescence intensity, degree of resection, perioperative complications, and postoperative neurological factors were evaluated.
UNASSIGNED: The pAC group included 16 patients (12 males, 4 females), and the NaFlg-AC group comprised 21 (13 males, 7 females). The mean patient ages for males and females were 61.4 years (61.4 ± 9.5 years) and 60.4 years (60.6 ± 12 years), respectively. The most common origin of the metastatic lesion was the lung in both the pAC and NaFlg-AC groups (n = 12 vs. n = 14, respectively). Gross total resection (GTR) was achieved in 85.7% of the patients in the NaFlg-AC group, whereas the GTR rate was 68.7% in the pAC group. There was no significant difference in GTR rates between the 2 groups (p = 0.254). The mean duration of the resection time was significantly shorter in the NaFlg-AC group (45.95 ± 7.00 min vs. 57.5 ± 12.51 min; p = 0.002). The patients\' Karnofsky Performance Status (KPS) score did not reach statistical significance at 6-month follow-up in either group compared to their preoperative baseline scores (p = 0.374). KPS did not show a significant difference between the 2 groups at any time.
UNASSIGNED: Fluorescence-guided resection in AC for metastatic tumors in sensory, motor, and cognitive areas is a feasible, safe, and convenient technique that significantly increases GTR rates and shortens operative time compared to conventional white light surgery without fluorescence guidance. It also does not increase the incidence of postoperative complications. With the combined use of AC and NaFl, ensuring clear and visible tumor margins during surgery and controlling patients\' neurological function in real-time are possible.
UNASSIGNED: Patients who underwent AC due to brain metastasis in the Department of Neurosurgery of Uludağ University\'s Faculty of Medicine between January 1, 2018 and August 1, 2022, were retrospectively analyzed. The study comprised 2 patient groups: plain AC (pAC) and NaFl-guided AC (NaFlg-AC). Surgical outcomes related to fluorescence intensity, degree of resection, perioperative complications, and postoperative neurological factors were evaluated.
UNASSIGNED: The pAC group included 16 patients (12 males, 4 females), and the NaFlg-AC group comprised 21 (13 males, 7 females). The mean patient ages for males and females were 61.4 years (61.4 ± 9.5 years) and 60.4 years (60.6 ± 12 years), respectively. The most common origin of the metastatic lesion was the lung in both the pAC and NaFlg-AC groups (n = 12 vs. n = 14, respectively). Gross total resection (GTR) was achieved in 85.7% of the patients in the NaFlg-AC group, whereas the GTR rate was 68.7% in the pAC group. There was no significant difference in GTR rates between the 2 groups (p = 0.254). The mean duration of the resection time was significantly shorter in the NaFlg-AC group (45.95 ± 7.00 min vs. 57.5 ± 12.51 min; p = 0.002). The patients\' Karnofsky Performance Status (KPS) score did not reach statistical significance at 6-month follow-up in either group compared to their preoperative baseline scores (p = 0.374). KPS did not show a significant difference between the 2 groups at any time.
UNASSIGNED: Fluorescence-guided resection in AC for metastatic tumors in sensory, motor, and cognitive areas is a feasible, safe, and convenient technique that significantly increases GTR rates and shortens operative time compared to conventional white light surgery without fluorescence guidance. It also does not increase the incidence of postoperative complications. With the combined use of AC and NaFl, ensuring clear and visible tumor margins during surgery and controlling patients\' neurological function in real-time are possible.
摘要：
■清醒开颅术（AC）可最大程度地切除雄辩的大脑区域的病变，同时保留功能。术中使用荧光素钠(NaFl)的肿瘤勾画有利于全切除。与AC一起使用时，它可能允许安全的切除，而不会增加术后神经功能缺损的风险。该研究调查了NaFl和AC的联合使用用于脑转移患者的最大安全切除的功效和安全性。
■2018年1月1日至2022年8月1日在乌卢达大学医学院神经外科因脑转移而接受AC的患者进行了回顾性分析。该研究包括2个患者组:普通AC(pAC)和NaFl引导的AC(NaFlg-AC)。与荧光强度相关的手术结果，切除程度,围手术期并发症,并对术后神经因素进行评估。
■pAC组包括16名患者（12名男性，4名女性），NaFlg-AC组由21人组成(13名男性，7名女性）。男性和女性的平均患者年龄分别为61.4岁（61.4±9.5岁）和60.4岁（60.6±12岁），分别。在pAC和NaFlg-AC组中，转移性病变的最常见起源是肺（n=12vs.分别为n=14)。NaFlg-AC组中85.7%的患者实现了总切除(GTR),而pAC组GTR率为68.7%。两组之间的GTR率没有显着差异（p=0.254）。NaFlg-AC组的平均切除时间明显缩短（45.95±7.00minvs.57.5±12.51分钟；p=0.002）。两组患者的Karnofsky表现状态（KPS）评分在随访6个月时与其术前基线评分相比均未达到统计学意义（p=0.374）。KPS在任何时间均未显示2组之间的显着差异。
■在AC中的荧光引导切除术用于感觉转移性肿瘤，电机,认知领域是可行的，安全,和方便的技术，显着提高GTR率和缩短手术时间相比，传统的白光手术没有荧光引导。它也不会增加术后并发症的发生率。随着AC和NaFl的结合使用，确保手术期间肿瘤边缘清晰可见，并实时控制患者的神经功能是可能的。
■2018年1月1日至2022年8月1日在乌卢达大学医学院神经外科因脑转移而接受AC的患者进行了回顾性分析。该研究包括2个患者组:普通AC(pAC)和NaFl引导的AC(NaFlg-AC)。与荧光强度相关的手术结果，切除程度,围手术期并发症,并对术后神经因素进行评估。
■pAC组包括16名患者（12名男性，4名女性），NaFlg-AC组由21人组成(13名男性，7名女性）。男性和女性的平均患者年龄分别为61.4岁（61.4±9.5岁）和60.4岁（60.6±12岁），分别。在pAC和NaFlg-AC组中，转移性病变的最常见起源是肺（n=12vs.分别为n=14)。NaFlg-AC组中85.7%的患者实现了总切除(GTR),而pAC组GTR率为68.7%。两组之间的GTR率没有显着差异（p=0.254）。NaFlg-AC组的平均切除时间明显缩短（45.95±7.00minvs.57.5±12.51分钟；p=0.002）。两组患者的Karnofsky表现状态（KPS）评分在随访6个月时与其术前基线评分相比均未达到统计学意义（p=0.374）。KPS在任何时间均未显示2组之间的显着差异。
■在AC中的荧光引导切除术用于感觉转移性肿瘤，电机,认知领域是可行的，安全,和方便的技术，显着提高GTR率和缩短手术时间相比，传统的白光手术没有荧光引导。它也不会增加术后并发症的发生率。随着AC和NaFl的结合使用，确保手术期间肿瘤边缘清晰可见，并实时控制患者的神经功能是可能的。
