Sodium Fluorescence-Guided Resection of Brain Tumors: Retrospective Analysis of a Series of 237 Patients and Evaluation of its Usefulness According to Histopathologic Diagnosis

Year 2024, Volume: 50 Issue: 2, 121 - 129, 08.10.2024

Alper Türkkan , Ahmet Bekar

https://doi.org/10.32708/uutfd.1452367

Abstract

Surgical resection is one of the most important prognostic factors in the treatment of patients with brain tumors. Sodium fluorescein (NaFl) is a fluorescent agent used for intraoperative imaging in brain tumors. It produces a green fluorescent color in tumoral tissue under microscope light equipped with a special filter (FL 560 nm). However, it cannot provide the same fluorescence intensity in all intracranial tumors. In this study, we aimed to investigate the fluorescence effect of NaFl in the surgery of brain tumors with different histopathological diagnoses. Data of a total of 237 patients who underwent NaFl-guided surgery for brain tumors between 2020 and 2023 were retrospectively analyzed. Age, gender, preoperative and postoperative neurological examination, degree of tumor resection, histopathological diagnosis, and degree of intraoperative NaFl staining were analyzed. Histopathologically, 73 (30.8%) metastatic tumors, 68 (28.7%) glioblastoma multiforme, 41 (17.3%) meningioma, 21 (8.9%) anaplastic astrocytoma, 10 (4.2%) oligodendroglioma, 6 (2.5%) pilocytic astrocytoma, 6 (2.5%) epidermoid tumor, 5 (2.1%) schwannoma, 3 (1.3%) lymphoma, 2 (0.8%) dysembryoplastic neuroectodermal tumor and 2 (0.8%) ependymoma. Intraoperative NaFl staining was observed in 211 (89%) patients. NaFl staining was observed in all glioblastoma multiforme and meningiomas and in 90.4% of metastatic tumors. None of the oligodendrogliomas and epidermoid tumors showed NaFl staining (p<0.001). The use of NaFL is effective in determining tumor margins intraoperatively, especially in high-grade glial tumors and metastatic lesions. However, there are limitations in its use according to tumor histopathology, dose and time of application.

Keywords

Sodium fluorescein, brain tumor, fluorescence-guided surgery

Beyin Tümörlerinin Sodyum Floresan Kılavuzluğunda Rezeksiyonu: 237 Hastadan Oluşan Bir Serinin Retrospektif Analizi ve Histopatolojik Tanıya Göre Yararlılığının Değerlendirilmesi

Abstract

Beyin tümörlü hastaların tedavisinde cerrahi rezeksiyon en önemli prognostik faktörlerden biridir. Sodyum floresan (NaFl), beyin tümörlerinde introperatif görselleştirme için kullanılan floresan bir maddedir. Özel filtre (FL 560 nm) ile donatılmış mikroskop ışığının altında tümöral dokuda yeşil floresan renk oluşmasını sağlar. Bununla birlikte intrakranial yerleşimli her tümörde aynı oranda floresan yoğunluğu sağlayamaz. Bu çalışmada farklı histopatolojik tanılardaki beyin tümörlerinin cerrahisinde NaFl’nin floresan etkisini ve güvenliğini araştırmak amaçlanmıştır.2020-2023 yılları arasında beyin tümörü nedeniyle NaFl rehberliğinde opere edilen toplam 237 hastanın verileri retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, preoperatif ve postoperatif nörolojik muayenesi, tümör rezeksiyon derecesi, histopatolojik tanısı ve intraoperatif NaFl ile boyanma derecesi analiz edildi. Histopatolojik olarak 73 (%30.8) metastatik tümör, 68 (%28.7) glioblastoma multiforme, 41 (%17.3) menengioma, 21 (%8.9) anaplastik astrositoma, 10 (%4.2) oligodendroglioma, 6 (%2.5) pilositik astrositoma, 6 (%2.5) epidermoid tümör, 5 (%2.1) schwannoma, 3 (%1.3) lenfoma, 2 (%0.8) disembriyoplastik nöroektodermal tümör ve 2 (%0.8) ependimoma tanılı hasta mevcuttu. İntraoperatif olarak 211 (%89) hastada NaFl ile boyanma izlendi. Glioblastoma multiforme ve menengiomaların tamamında, metastatik tümörlerin %90.4’ünde NaFl boyanması gözlendi. Oligodendrogliomaların ve epidermoid tümörlerin hiçbirisinde boyanma saptanmadı (p<0.001). NaFL kullanımı, özellikle yüksek dereceli glial tümörlerde ve metastatik lezyonlarda intraoperatif olarak tümör sınırlarının belirlenmesine etkilidir. Bununla birlikte tümör histopatolojisine, uygulama dozu ve zamanına göre kullanımında sınırlamalar mevcuttur.

Keywords

Sodyum floresan, beyin tümörü, floresan rehberliğinde cerrahi

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