ABSTRACT
In recent years, fluorescence navigation has been increasingly used in surgery for gliomas. In most studies, 5-ALA derivatives are used as fluorescence inducers. However, there are few data regarding E6 chlorin for these purposes. OBJECTIVE: To evaluate an effectiveness and feasibility of fluorescence navigation with chlorin E6 in surgery of brain gliomas. MATERIAL AND METHODS: The study included 30 patients with glial brain tumors grade II-IV. All patients were operated at the Polenov Russian Neurosurgical Institute. We used surgical microscope (Leica OHS-1), D-Light AF System (Karl Storz, Germany), original fluorescence module (St. Petersburg LOMO, developed by G.V. Papayan) and special software RSS Cam - Endo 1.4.313 for visual analysis of fluorescence. Histological examination included hematoxylin-eosin staining of specimens and immunohistochemical studies. RESULTS: Fluorescence was weak in all patients with Grade II gliomas and strong in almost all patients with Grade III-IV gliomas. Sensitivity of fluorescence diagnosis with chlorin E6 was 72.2% for Grade II gliomas, 83.8% for Grade III gliomas and 87.7% for Grade IV. Specificity of this method was 60% for Grade II gliomas, 66.7% for Grade III gliomas and 85.2% for Grade IV. CONCLUSION: Certain method of fluorescence imaging ensured resection of glial brain tumors using chlorin E6. Intensity of tumor fluorescence correlated with glioma malignancy grade. These results indicate that chlorin E6 is an effective photosensitizer for intraoperative fluorescence diagnosis in surgery for glioma.
Subject(s)
Brain Neoplasms , Glioma , Aminolevulinic Acid , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/surgery , Chlorophyllides , Fluorescence , Glioma/surgery , Humans , Neurosurgical Procedures , PorphyrinsABSTRACT
OBJECTIVE: To analyze the characteristics of paroxysmal syndrome in insular and temporal lobe tumors, to determine their relationship with the histological structure of tumor, to assess the effect of tumor growth nature on severity of disease. MATERIAL AND METHODS: A retrospective analysis enrolled 80 patients aged 11 - 80 years with insular and temporal lobe tumors and symptomatic epilepsy. All patients underwent surgery at the Polenov National Research Neurosurgery Center in Almazov National Medical Research Center for the period from 2012 to 2018. RESULTS: The main group consisted of 29 patients with tumors of temporal and insular lobes. Control group of 51 patients with temporal gliomas was formed for comparative analysis. It was found that involvement of insular lobe into paroxysmal syndrome is characterized by attacks with a motor component, somatosensory paroxysms, vegetative manifestations (respiratory attacks, salivation, nausea), speech disorders and taste hallucinations. Derealization, motor arrest and déjà vu/jamis vu paroxysms were more common in patients with temporal lobe lesion. Neoplastic lesion of the insular lobe shortens the period between manifestation of paroxysms and surgical treatment. Moreover, this type of disease is characterized by higher incidence of seizures compared to isolated temporal lobe tumors.
Subject(s)
Epilepsy, Temporal Lobe/surgery , Glioma , Supratentorial Neoplasms , Adolescent , Adult , Aged , Aged, 80 and over , Cerebral Cortex , Child , Electroencephalography , Humans , Magnetic Resonance Imaging , Middle Aged , Retrospective Studies , Temporal Lobe/diagnostic imaging , Young AdultABSTRACT
Surgery for brain metastases is an effective treatment for most cancer patients. It involves low post-operative lethality (2.9%) and causes neurological symptoms to regress in most patients. 12-month survival occured in 48.5%, 5 years--10.8%; mean survival duration with good quality of life--11.8 months. Survival basically depended on tumor pattern, metastases to other organs, multiple foci in the brain and habitus.
