Por Renan Maximilian Lovato, João Luiz Vitorino Araujo, Aline Lariessy Campos Paiva e José Carlos Esteves Veiga
Abstract
BACKGROUND: Gross total resection for malignant brain neoplasms is an important oncological principle and a major part of the treatment with crucial impact on prognosis. It is a challenge due to the heterogeneity of these lesions and its infiltration in eloquent areas. Some resources are useful to maximize the extension with safety and minimal sequelae. Fluorescence guided surgery is a safe, cheap and important tool that improves the rate of total resection. It is described a case series in which fluorescein is used in malignant brain tumor surgeries (for gliomas and metastasis).
METHODS: We have built a 3D printed device with an excitation and a barrier filter to use in surgical microscopes. The patients received an intravenous dose sodium fluorescein before skin incision. Surgical view under white light was compared to the use of the light filters.
RESULTS: In all cases with the use of our device the tumors showed a high fluorescence, but not in the normal surrounding brain. This tool makes easier to identify the lesion and to achieve gross total resection with minimum damage to neighboring tissue.
CONCLUSION: Fluorescence guided surgery increases the rate of gross total resection of malignant brain tumors. This is an important tool with a potential impact on overall survival of the patients. This is a low cost option that could make this technology available in low resources areas.
Topic: brain tumors heterogeneity fluorescein fluorescence glioma neoplasm metastasis safety surgical procedures, operative brain neoplasms skin sodium fluorescein devices, medical filters white light operating microscopes printing, three-dimensional excitation
Issue Section: Tumor Models
