Fluorescence-Guided Surgery and Biopsy in Gliomas with an Exoscope System

Abstract EN

Background.

The introduction of fluorescence-guided resection allows a better identification of tumor tissue and its more radical resection.

We describe our experience with a modified exoscope to detect 5 ALA-induced fluorescence in neuronavigation-guided brain surgery or biopsy of malignant brain tumors.

Methods.

Thirty-eight patients with a suspected preoperative diagnosis of high-grade astrocytoma were included.

We used a neuronavigation device and a high-definition exoscope system with a built-in filter to detect 5-ALA fluorescence in all cases.

Thirty patients underwent craniotomy with tumor resection and 8 underwent frameless stereotactic brain biopsy.

Results.

Histopathological diagnosis confirmed the presence of high-grade gliomas in 34 patients.

Total resection was achieved in 23 cases and subtotal in 7.

No relevant complications related to the administration of 5-ALA were detected.

Conclusions.

The use of the exoscope in 5-ALA fluorescence-guided tumor surgery has twofold implications: during brain tumor surgery it can be considered a valuable tool to achieve a more radical resection of the lesion, and when applied to a biopsy of a suspected brain high-grade glioma, it decreases the possibility of a negative biopsy.