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Maximizing GBM Resection: Fluorescence Techniques

December 02, 2015


This is Aaron Cohen. This video describes techniques for maximizing high-grade glioma resection using fluorescing fluorescence techniques. This is a case of a 66 year old male who presented with a right occipital high-grade glioma extending into the ventricle. He subsequently underwent a right cluster temporoparietal craniotomy. Under fluorescence module or YELLOW 560 you can see that dura is enhancing. However, the resection cavity and a normal brain is relatively uncontaminated. We use fluorescence guidance to expose the capsule of the tumor, the external capsule of the tumor that is very evident and highly stained with fluorescing. You can see that under white light, actually this portion of the tumor, which is the most proliferative part can be relatively unremarkable at certain locations. Here you can see relatively no clear demarkation however under florescence you can see the tumor that is enhancing versus the normal white matter tract that is relatively pink and normal. These data clearly corresponds to those of stealth neuronavigation. I continue to use my bipolars to dissect the tumor from the surrounding white matter tracts. This fluorescence techniques, specially useful for those tumor nodules that extend into the white matter tracts. Here you can see those nodules that extend toward the ventricle can be easily followed using the fluorescence data. Here, reaching the ventricle and the choroid plexus. And you can see how the tumor is extending into the ventricle as confirmed by stealth neuronavigation data. Continuation of the next steps allows us to completely remove the tumor and furthermore remove residual nodules. At the end of resection, the resection cavity is relatively clean and only minimally contaminated with fluorescence. There is cell florescence in the CSF from the ventricle, the postoperative MRI reveals gross total resection of the tumor without any complicating features. Thank you.

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