术中应用荧光素钠有利于胶质母细胞瘤浸润边缘的手术切除（英文）

作     者：Neira JA Ung TH Sims J Malone HR Chow DS Samanamud JL Zanazzi GJ Guo X Bowden SG Zhao B Sheth SA McKhann GM 2nd Sisti MB Canoll P D'Amico RS Bruce JN 

作者机构：Department of Neurological SurgeryColumbia University Medical Center Department of NeuroradiologyColumbia University Medical Center Department of Pathology and Cell BiologyColumbia University Medical Center Department of RadiologyColumbia University Medical Center 

出 版 物：《中华神经外科疾病研究杂志》 (Chinese Journal of Neurosurgical Disease Research)

年 卷 期：2016年第15卷第5期

页      面：465-465页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：神经外科学 疾病研究 医学研究 临床分析 

摘      要：Objective Extent of resection is an important prognostic factor in patients undergoing surgery for glioblastoma( GBM).Recent evidence suggests that intravenously administered fluorescein sodium associates with tumor tissue,facilitating safe maximal resection of GBM. In this study,the authors evaluate the safety and utility of intraoperative fluorescein guidance for the prediction of histopathological alteration both in the contrast-enhancing( CE) regions,where this relationship has been established,and into the nonCE( NCE),diffusely infiltrated margins. Methods Thirty-two patients received fluorescein sodium( 3 mg/kg) intravenously prior to resection. Fluorescence was intraoperatively visualized using a Zeiss Pentero surgical microscope equipped with a YELLOW 560 *** localized biopsy specimens were acquired from CE and NCE regions based on preoperative MRI in conjunction with neuronavigation. The fluorescence intensity of these specimens was subjectively classified in real time with subsequent quantitative image analysis,histopathological evaluation of localized biopsy specimens,and radiological volumetric assessment of the extent of *** Bright fluorescence was observed in all GBMs and localized to the CE regions and portions of the NCE margins of the tumors,thus serving as a visual guide during resection. Gross-total resection( GTR) was achieved in 84% of the patients with an average resected volume of 95%,and this rate was higher among patients for whom GTR was the surgical goal( GTR achieved in 93. 1% of patients,average resected volume of 99. 7%). Intraoperative fluorescein staining correlated with histopathological alteration in both CE and NCE regions,with positive predictive values by subjective fluorescence evaluation greater than 96% in NCE regions. Conclusions Intraoperative administration of fluorescein provides an easily visualized marker for glioma pathology in both CE and NCE regions of GBM. These findingssupport the u