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Fluorescence-guidance in non-Gadolinium enhancing, but FET-PET positive gliomas
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Fluorescence-guidance in non-Gadolinium enhancing, but FET-PET positive gliomas
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Journal Article
Fluorescence-guidance in non-Gadolinium enhancing, but FET-PET positive gliomas
2018
Overview
•Fluorescein sodium under a dedicated surgical microscope filter can guide the surgical removal of distinct non-Gadolinium enhancing gliomas.•Fluorescein sodium fluorescence seems to correlate to metabolic active areas within gliomas, confirmed by FET-PET.•Combination of FET-PET, navigation and fluorescence-guidance potentially increases safety and accuracy in non-Gadolinium enhancing gliomas.
We report on five patients with gadolinium-negative (non-enhancing magnetic resonance imaging–MRI) but 18F-fluoroethyl tyrosine positron-emission tomography (FET-PET) positive glioma (NEG) undergoing surgery under fluorescence-guidance with fluorescein sodium 10% (FL, Alkon, Germany) in combination with a dedicated light filter (YELLOW 560 nm, Carl Zeiss Meditec, Germany).
Since 2017, five patients (3 female, 2 male; mean age 45.4 years) underwent fluorescence-guided surgery for supratentorial, intracerebral lesions which showed no contrast-enhancement in the preoperative MRI but were, however, strongly suspicious for gliomas. Accordingly, all patients received a preoperative FET-PET scan and detailed histopathological workup was performed. After giving written informed consent, all patients received 5 mg/kg of FL at the induction of anesthesia. Surgery was conducted under white light and under the YELLOW 560 nm filter. We reviewed the surgical protocols, navigational storage and the image databases of our surgical microscopes for evidence of intraoperative fluorescence that corresponded to the FET-PET positive area.
In all patients we found distinct accordances between the FET-PET positive areas and the fluorescing regions within the targeted lesions. Histopathological workup of the fluorescent tissue revealed anaplastic oligodendroglioma, IDH-mutant and 1p/19-codeleted (WHO grade III) (n = 2), anaplastic astrocytoma, IDH-mutant (WHO grade III) (n = 1), oligodendroglioma, IDH-mutant and 1p/19q-codeleted (WHO grade II) (n = 1) and pilocytic astrocytoma (WHO grade I) (n = 1). No adverse events were noted.
Despite the lack of gadolinium-enhancement in the preoperative MRI, all patients intravenously received FL to guide resection. Irrespective of the final grading, FL was extremely helpful in detecting the lesions and in identifying their border zones. In selected patients with NEG, but strong metabolic activity according to the FET-PET, FL may significantly increase the accuracy of surgery.
Publisher
Elsevier B.V,Elsevier Limited
Subject
/ Astrocytoma - diagnostic imaging
/ Brain Neoplasms - diagnostic imaging
/ Female
/ FET-PET
/ Glioma
/ Humans
/ Light
/ Magnetic Resonance Imaging - methods
/ Male
/ NMR
/ Oligodendroglioma - diagnostic imaging
/ Positron emission tomography
/ Positron-Emission Tomography - methods
/ Sodium
/ Surgery
/ Tumors
/ Tyrosine
