Clinical application of intraoperative fluorescence in nerve tumor surgery

doi:10.3877/cma.j.issn.2095-9141.2022.02.010

Abstract

Abstract:

Fluorescence guided resection of nerve tumors is the development direction in recent years. The application of tumor fluorescent agent has changed the operation mode and concept of tumor neurosurgery. Tumor fluorescence localization technology can locate the tumor, mark the tumor boundary, guide the safe and maximum resection of the tumor, so as to improve the total resection rate and neurovascular protection rate, and prolong the progression free survival time. 5-aminolevulinic acid (5-ALA), fluorescein sodium (FLS) and indocyanine green (ICG) are commonly used fluorescent agents in the resection of nerve tumors. 5-ALA induces the survival of fluorescent protoporphyrin IX and guides tumor resection. Although FLS is not a tumor cell specific fluorescent agent, it has become a new alternative to fluorescence guided resection of nerve tumors because of its safety, effectiveness and convenience. ICG has a good application prospect for vascular tumors, such as hemangioblastoma. This article mainly reviews the application of fluorescence guided technology in neurooncology, and discusses the fluorescence localization technology and clinical application, in order to provide reference for clinic.

Key words: Tumor fluorescence, Fluorescence guided surgery, 5-aminolevulinic acid, Fluorescein sodium, Indocyanine green

Lihua Chen, Yong Xia, Ruxiang Xu. Clinical application of intraoperative fluorescence in nerve tumor surgery[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(02): 111-116.

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References 29

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参数	5-ALA	FLS
物质类型	药物：血红蛋白的前体	染料：荧光素钠盐
作用机制	选择性诱导肿瘤细胞合成荧光卟啉IX	通过受损的血脑屏障
剂量	20 mg/kg	1~5 mg/kg
注射时间和方式	术前2~3 h口服	术中静脉注射
荧光可视化	可视化专用滤光片：需要（蔡司-徕卡）；	专用滤镜：需要（高剂量除外）（蔡司）；
	滤光片特性：对荧光有很好的分辨力；	滤镜特点：荧光组织分辨力强；
	组织：瘤周区显示不佳	肿瘤周围区域显示更自然的颜色
肿瘤GTR	65%~75%	75%~100%

参数	5-ALA	FLS
物质类型	药物：血红蛋白的前体	染料：荧光素钠盐
作用机制	选择性诱导肿瘤细胞合成荧光卟啉IX	通过受损的血脑屏障
剂量	20 mg/kg	1~5 mg/kg
注射时间和方式	术前2~3 h口服	术中静脉注射
荧光可视化	可视化专用滤光片：需要（蔡司-徕卡）；	专用滤镜：需要（高剂量除外）（蔡司）；
	滤光片特性：对荧光有很好的分辨力；	滤镜特点：荧光组织分辨力强；
	组织：瘤周区显示不佳	肿瘤周围区域显示更自然的颜色
肿瘤GTR	65%~75%	75%~100%

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