Intraoperative Fluorescence Imaging for Brain Tumor Resection
No Thumbnail Available
Date
2022
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Augstas pakāpes gliomas pieaugušajiem ir visizplatītākie un agresīvākie smadzeņu audzēji. Gadā tiek diagnosticēti gandrīz 20 000 jaunu gadījumu. Pat ar pašreizējām ārstēšanas metodēm, piemēram, staru terapiju, ķīmijterapiju un ķirurģiju, pacienta prognoze joprojām ir drūma audzēja infiltratīvā rakstura dēļ. Pastāv spēcīga korelācija starp izdzīvošanu un maksimālo rezekcijas apjomu operācijas laikā. Tā kā normālu smadzeņu audu ir grūti atšķirt no neoplastiskiem audiem, kopējās rezekcijas sasniegšana ir izaicinājums. Šī iemesla dēļ ir izstrādāta fluorescences vadīta ķirurģija. Tas izceļ audzēja audus no normāliem smadzeņu audiem, dodot ķirurgam iespēju operēt tieši ļaundabīgo daļu. Vairāki pētījumi ir parādījuši, ka intraoperatīva fluorescences vadīta operācija ir labāka par baltās gaismas operāciju, ja tiek novērtēta kopējā rezekcija. Visbiežāk izmantotie fluorofori ir 5-aminolevulīnskābe, nātrija fluorescence un indocianīna zaļais. Bieži lietoto līdzekļu trūkumu dēļ ir izstrādāti jauni fluorofori. Šie jaunie, mērķtiecīgie fluorofori var nodrošināt vēl lielāku selektivitāti un uzlabot kopējo kopējo summu, salīdzinot ar 5-aminolevulīnskābi, nātrija fluorescenci un indocianīna zaļo. Tomēr šie fluorofori joprojām atrodas preklīniskajos vai agrīnajos klīniskajos pētījumos.
High grade gliomas in adults are the most common and aggressive brain tumors. There are almost 20 000 new diagnosed cases per year. Even with current treatment methods, such as radiotherapy, chemotherapy, and surgery, patient prognosis remains bleak due to the infiltrative nature of the tumor. There is a strong correlation between survival and maximal extent of resection during surgery. Due to difficult differentiation of normal brain tissue from neoplastic tissue, achieving gross total resection is a challenge. For this reason, fluorescence guided surgery has been developed. It highlights tumor tissue from the normal brain tissue giving the surgeon a possibility to operate directly on the malignant part. Multiple studies have shown that intraoperative fluorescence guided surgery is superior to white light surgery when gross total resection is evaluated. 5-aminolevulinic acid, sodium fluorescence and indocyanine green are the most commonly used fluorophores. Due to disadvantages with commonly used agents, novel fluorophores have been developed. These novel, targeted, fluorophores may provide even higher selectivity and improve gross total compared to 5-aminolevulinic acid, sodium fluorescence and indocyanine green. However, these fluorophores are still in preclinical or early clinical trials.
High grade gliomas in adults are the most common and aggressive brain tumors. There are almost 20 000 new diagnosed cases per year. Even with current treatment methods, such as radiotherapy, chemotherapy, and surgery, patient prognosis remains bleak due to the infiltrative nature of the tumor. There is a strong correlation between survival and maximal extent of resection during surgery. Due to difficult differentiation of normal brain tissue from neoplastic tissue, achieving gross total resection is a challenge. For this reason, fluorescence guided surgery has been developed. It highlights tumor tissue from the normal brain tissue giving the surgeon a possibility to operate directly on the malignant part. Multiple studies have shown that intraoperative fluorescence guided surgery is superior to white light surgery when gross total resection is evaluated. 5-aminolevulinic acid, sodium fluorescence and indocyanine green are the most commonly used fluorophores. Due to disadvantages with commonly used agents, novel fluorophores have been developed. These novel, targeted, fluorophores may provide even higher selectivity and improve gross total compared to 5-aminolevulinic acid, sodium fluorescence and indocyanine green. However, these fluorophores are still in preclinical or early clinical trials.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Intraoperatīvā attēlveidošana, fluorescence, 5-ALA, nātrija fluoresceīns, indocianīna zaļš, jauni fluorofori, augstas kvalitātes glioma, Intraoperative imaging, Fluorescence, 5-ALA, Sodium fluorescein, Indocyanine green, Novel fluorophores, High grade glioma