Julius Höhne1,2, Christoph Hohenberger3,4, Martin Proescholdt3,4, Markus J Riemenschneider5,4, Christina Wendl6,4, Alexander Brawanski3,4, Karl-Michael Schebesch3,4. 1. Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany. julius.hoehne@ukr.de. 2. Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. julius.hoehne@ukr.de. 3. Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany. 4. Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. 5. Institute of Neuropathology, University Medical Center Regensburg, Regensburg, Germany. 6. Institute of Radiology, Neuroradiology Branch, University Medical Center Regensburg, Regensburg, Germany.
Abstract
BACKGROUND: Cerebral metastasis (CM) is the most common malignancy affecting the brain. In patients eligible for surgery, complete tumor removal is the most important predictor of overall survival and neurological outcome. The emergence of surgical microscopes fitted with a fluorescein-specific filter have facilitated fluorescein-guided microsurgery and identification of tumor tissue. In 2012, we started evaluating fluorescein (FL) with the dedicated microscope filter in cerebral metastases (CM). After describing the treatment results of our first 30 patients, we now retrospectively report on 95 patients. METHODS: Ninety-five patients with CM of different primary cancers were included (47 women, 48 men, mean age, 60 years, range, 25-85 years); 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560-nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control. The extent of resection (EOR) was assessed by means of early postoperative contrast-enhanced MRI and the grade of fluorescent staining as described in the surgical reports. Furthermore, we evaluated information on neurological outcome and surgical complications as well as any adverse events. RESULTS: Ninety patients (95%) showed bright fluorescent staining that markedly enhanced tumor visibility. Five patients (5%); three with adenocarcinoma of the lung, one with melanoma of the skin, and one with renal cell carcinoma) showed insufficient FL staining. Thirteen patients (14%) showed residual tumor tissue on the postoperative MRI. Additionally, the MRI of three patients did not confirm complete resection beyond doubt. Thus, gross-total resection had been achieved in 83% (n = 79) of patients. No adverse events were registered during the postoperative course. CONCLUSIONS: FL and the YELLOW 560-nm filter are safe and feasible tools for increasing the EOR in patients with CM. Further prospective evaluation of the FL-guided technique in CM-surgery is in planning.
BACKGROUND: Cerebral metastasis (CM) is the most common malignancy affecting the brain. In patients eligible for surgery, complete tumor removal is the most important predictor of overall survival and neurological outcome. The emergence of surgical microscopes fitted with a fluorescein-specific filter have facilitated fluorescein-guided microsurgery and identification of tumor tissue. In 2012, we started evaluating fluorescein (FL) with the dedicated microscope filter in cerebral metastases (CM). After describing the treatment results of our first 30 patients, we now retrospectively report on 95 patients. METHODS: Ninety-five patients with CM of different primary cancers were included (47 women, 48 men, mean age, 60 years, range, 25-85 years); 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560-nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control. The extent of resection (EOR) was assessed by means of early postoperative contrast-enhanced MRI and the grade of fluorescent staining as described in the surgical reports. Furthermore, we evaluated information on neurological outcome and surgical complications as well as any adverse events. RESULTS: Ninety patients (95%) showed bright fluorescent staining that markedly enhanced tumor visibility. Five patients (5%); three with adenocarcinoma of the lung, one with melanoma of the skin, and one with renal cell carcinoma) showed insufficientFL staining. Thirteen patients (14%) showed residual tumor tissue on the postoperative MRI. Additionally, the MRI of three patients did not confirm complete resection beyond doubt. Thus, gross-total resection had been achieved in 83% (n = 79) of patients. No adverse events were registered during the postoperative course. CONCLUSIONS:FL and the YELLOW 560-nm filter are safe and feasible tools for increasing the EOR in patients with CM. Further prospective evaluation of the FL-guided technique in CM-surgery is in planning.
Authors: Matthew Tucker; Matthew Lacayo; Suzanna Joseph; Weston Ross; Pakawat Chongsathidkiet; Peter Fecci; Patrick J Codd Journal: Proc SPIE Int Soc Opt Eng Date: 2022-03-04
Authors: Karl-Michael Schebesch; Katharina Rosengarth; Alexander Brawanski; Martin Proescholdt; Christina Wendl; Julius Höhne; Christian Ott; Hans Lamecker; Christian Doenitz Journal: Front Surg Date: 2019-10-01
Authors: Semih Kivanc Olguner; Ali Arslan; Vedat Açık; İsmail İstemen; Mehmet Can; Yurdal Gezercan; Ali İhsan Ökten Journal: Front Oncol Date: 2021-01-28 Impact factor: 6.244
Authors: Alexander J Schupper; Manasa Rao; Nicki Mohammadi; Rebecca Baron; John Y K Lee; Francesco Acerbi; Constantinos G Hadjipanayis Journal: Front Neurol Date: 2021-06-16 Impact factor: 4.003
Authors: Julius Höhne; Francesco Acerbi; Jacopo Falco; Mehmet Osman Akçakaya; Nils Ole Schmidt; Talat Kiris; Camilla de Laurentis; Paolo Ferroli; Morgan Broggi; Karl-Michael Schebesch Journal: J Clin Med Date: 2020-07-28 Impact factor: 4.241
Authors: Martin A Proescholdt; Petra Schödel; Christian Doenitz; Tobias Pukrop; Julius Höhne; Nils Ole Schmidt; Karl-Michael Schebesch Journal: Cancers (Basel) Date: 2021-03-31 Impact factor: 6.639