PDF(Pubmed)
Abstract：
Background: Glioma surgery has been remarkably enhanced in the past 2 decades, with improved safety and limited but improved life expectations. The fluorescence-guided resection of high-grade gliomas (HGGs) plays a central role in this sense, allowing a greater extent of resection (EOR). The introduction of exoscopic-guided surgery may be considered in implementing fluorescence techniques over traditional microscopes. We present the application and the advantages of exoscopic-guided surgery compared to microscopic surgery in tumor resection guided by 5-ALA fluorescence in patients with HGGs. Methods: Ten consecutive patients underwent surgery for HGG resection. The surgery was performed via an exoscopic-guided procedure (Olympus ORBEYE) and after the oral administration of Gliolan 5 h before the procedure. During surgery, the procedure shifted to using a microscopic (Kinevo 900, Zeiss) view. The intensity of the fluorescence under the two different procedures was subjectively measured in different picture samples during the surgery on a 1 to 5 (from minimum to maximum) scale. The brightness of the surgical field and the detailing of the anatomy were also analyzed comparatively. Results: Among the ten patients, the histopathological diagnosis was an high-grade glioma in all cases. In nine cases, it was possible to achieve gross total resection. There was no perioperative mortality. The median fluorescence intensity, on a scale of 1-5, was 4.5 in the exoscope group and 3.5 in the microscope group (p < 0.01). Conclusions: The exoscopic-guided surgery adds advantages to traditional fluorescence-guided surgery with 5-aminolevulinic acid. Beyond the important advantage of low cost and the possibility to perform collaborative surgeries, it adds a plain and continuous visualization of the tumor and offers advantages in the surgical field of fluorescence-guided glioma surgery compared to the microscopic-guided one.
摘要：
背景：在过去的20年里，胶质瘤手术得到了显著的加强，具有提高的安全性和有限但改善的生活期望。在这个意义上，荧光引导切除高级别胶质瘤（HGG）起着核心作用，允许更大程度的切除（EOR）。在传统显微镜上实施荧光技术时，可以考虑引入腹腔镜引导手术。我们介绍了在5-ALA荧光引导下HGG患者的肿瘤切除术中，与显微手术相比，腹腔镜引导手术的应用和优势。方法：连续10例患者接受HGG切除术。手术通过腹腔镜引导程序（OlympusORBEYE）进行，并在手术前5小时口服Gliolan后进行。手术期间,程序转向使用微观(Kinevo900，蔡司)视图。在手术期间以1至5(从最小到最大)的标度在不同的图片样品中主观地测量两种不同程序下的荧光强度。还比较分析了手术视野的亮度和解剖结构的细节。结果:10例患者中,所有病例的组织病理学诊断均为高级别胶质瘤.在九个案例中，有可能实现大体全切除.没有围手术期死亡。中值荧光强度，在1-5的范围内，出镜组为4.5，显微镜组为3.5（p<0.01）。结论：在5-氨基乙酰丙酸的荧光引导下，腹腔镜引导手术增加了传统的优势。除了低成本和进行协作手术的可能性的重要优势之外，与显微镜引导的手术相比，它增加了肿瘤的平面和连续可视化，并在荧光引导的神经胶质瘤手术领域提供了优势。
