Metastatik Beyin Tümörlerinin Mikrocerrahi Yönetiminde Sodyum Fluorescein Boyamanın Cerrahi Sonuçlara Etkileri

Amaç: Beyin tümörleri içerisinde en sık görülen grup olan metastazların mikrocerrahi ile çıkartılmasında yardımcı bir teknik olan tümör boyamanın cerrahi sonuçlarımıza yansımasını araştırdık. Gereç ve Yöntem: Metastatik beyin tümörü nedeni ile mikrocerrahi yöntem ile beyaz ışık altında opere edilen 21 hasta ve sodyum fluorescein (FL) boyama kullanılan 27 hasta retrospektif olarak değerlendirildi. Her iki grubun gross total rezeksiyon (GTR) oranları, cerrahi süreleri, kan kaybı miktarları, hastanede kalış süreleri karşılaştırıldı. FL kullanılan grupta boyamanın cerrahiye yaptığı katkı değerlendirildi. Bulgular: Çalışmaya toplamda 48 hasta alındı. Hastaların medyan yaşı 61,5 (minimum: 20 maksimum: 80) yıl, ortalama yaşı 59,1±11,8 yıl idi. FL kullanılmayan ve kullanılan gruplarda cinsiyet, yaş, tümör büyüklüğü, GTR oranları ve cerrahi süre açısından fark yoktu. FL kullanılan grupta kan kaybı miktarları ve hastanede kalış süresi belirgin şekilde azdı. FL kullanılan grupta yirmi beş hastada (%92,5) FL sarı röfle vererek cerrahiye katkı sağlamıştır. Sonuç: Metastatik beyin tümörlerinin cerrahisinde FL boyama kan kaybını ve cerrahi süreleri azaltmakta, tümör glial doku ayrımında cerraha yardımcı olmaktadır.

The Effects of Sodium Fluorescein Dyeing of Metastatic Brain Tumors on Surgical Outcomes Under Microsurgical Operation

Aim: We investigated the reflection of tumor dyeing (staining), an auxiliary technique for the resection of metastases, which are the most prevalentgroup among brain tumors, via microsurgery.Materials and Methods: Twenty one patients, who were operated under surgical white light, and 27 patients who were operated via sodiumfluorescein (FL) dyeing (staining) due to metastatic brain tumors were evaluated retrospectively. The gross total resection (GTR) rates, surgical time,amount of blood loss, and the duration of hospital stay for both groups were compared. The contribution of FL dyeing (staining) to surgery wasevaluated for the group with FL dyeing (staining).Results: The study comprised of 48 patients in total. The median age of patients was 61.5 years (minimum: 20, maximum: 80), the average age was59.1±11.8 years. There was no difference between the group with FL dyeing and the one without dyeing in terms of gender, age, tumor size, GTRrates and surgical time. Blood loss and duration of hospital stay in the FL used group was significantly less. In the group with FL dyeing (staining)(92.5%), this method contributed to the surgery by giving yellow highlights.Conclusion: It has been found out that in the surgery of metastatic brain tumors, FL dyeing decreases the blood loss, shortens the surgical time, andaids in the differentiation of tumor glial tissue.

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1. Arnold SM, Patchell RA. Diagnosis and management of brain metastases. Hematol Oncol Clin North Am. 2001;15:1085-107.
2. Soffietti R, Rudā R, Mutani R. Management of brain metastases. J Neurol. 2002;249:1357-69.
3. Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005;75:5-14.
4. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990 ;322:494-500.
5. MacGee EE. Surgical treatment of cerebral metastases from lung cancer. The effect on quality and duration of survival. J Neurosurg. 1971;35:416- 20.
6. Narita Y, Shibui S. Strategy of surgery and radiation therapy for brain metastases. Int J Clin Oncol. 2009;14:275-80.
7. Olesrud IC, Schulz MK, Marcovic L, Kristensen BW, Pedersen CB, Kristiansen C, et al. Early postoperative MRI after resection of brain metastasescomplete tumour resection associated with prolonged survival. Acta Neurochir (Wien). 2019;161:555-65.
8. Bush NA, Chang SM, Berger MS. Current and future strategies for treatment of glioma. Neurosurg Rev. 2017;40:1-14.
9. Weller M, van den Bent M, Tonn JC, Stupp R, Preusser M, Cohen-Jonathan- Moyal E, et al. European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol. 2017;18:e315-29.
10. Diaz RJ, Dios RR, Hattab EM, Burrell K, Rakopoulos P, Sabha N, et al. Study of the biodistribution of fluorescein in glioma-infiltrated mouse brain and histopathological correlation of intraoperative findings in high-grade gliomas resected under fluorescein fluorescence guidance. J Neurosurg. 2015;122:1360-9.
11. Koc K, Anik I, Cabuk B, Ceylan S. Fluorescein sodium-guided surgery in glioblastoma multiforme: a prospective evaluation. Br J Neurosurg. 2008;22:99-103.
12. Dilek O, Ihsan A, Tulay H. Anaphylactic reaction after fluorescein sodium administration during intracranial surgery. J Clin Neurosci. 2011;18:430-1.
13. Gempt J, Meyer B. Does fluorescein sodium-guided resection of cerebral metastases increase rates of total resections? Acta Neurochir (Wien). 2015;157:897.
14. Schebesch KM, Hoehne J, Hohenberger C, Proescholdt M, Riemenschneider MJ, Wendl C, et al. Fluorescein sodium-guided resection of cerebral metastases—experience with the first 30 patients. Acta Neurochir (Wien). 2015;157:899-904.
15. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37:745-51.
16. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43:795-803.
17. Murray KJ, Scott C, Zachariah B, Michalski JM, Demas W, Vora NL, et al. Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the Radiation Therapy Oncology Group protocol 91-04. Int J Radiat Oncol Biol Phys. 2000;48:59- 64.
18. Acerbi F, Broggi M, Eoli M, Anghileri E, Cuppini L, Pollo B, et al. Fluoresceinguided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases. Acta Neurochir (Wien). 2013;155:1277-86.
19. Marbacher S, Klinger E, Schwyzer L, Fischer I, Nevzati E, Diepers M, et al. Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases. Neurosurg Focus. 2014;36:E10.
20. Hamamcıoğlu MK, Akçakaya MO, Göker B, Kasımcan MÖ, Kırış T. The use of the YELLOW 560 nm surgical microscope filter for sodium fluoresceinguided resection of brain tumors: Our preliminary results in a series of 28 patients. Clin Neurol Neurosurg. 2016;143:39-45.
21. Okuda T, Kataoka K, Yabuuchi T, Yugami H, Kato A. Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium. J Clin Neurosci. 2010;17:118-21.
22. Diaz RJ, Dios RR, Hattab EM, Burrell K, Rakopoulos P, Sabha N, et al. Study of the biodistribution of fluorescein in glioma-infiltrated mouse brain and histopathological correlation of intraoperative findings in high-grade gliomas resected under fluorescein fluorescence guidance. J Neurosurg. 2015;122:1360-9.