Resection of High-Grade Gliomas: Application of Fluorescein Fluorescence

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This video reviews techniques for resection of high-grade gliomas using fluorescein fluorescence. This is the case of a 56 year old female who presented with confusion and seizures, and was noted to have a right trigonal or deep parietal enhancing lesion suspected to be a high grade glioma. She underwent a right parietal craniotomy through this superior parietal lobule as well as the inferior parietal lobule corticotomy to expose the tumor. You can see the dura does enhance with fluorescein since it lacks the blood-brain barrier. And initial corticotomy was created using neuro navigation data. Fluorescein fluorescence was used to continue white matter dissection, and you can see the capsule of the tumors evident. The cystic fluid of the tumor is expectedly contaminated with fluorescein as well. Neuronavigation data clearly corresponds with the fluorescence data. I'm using a pituitary rongeurs to remove pieces of the tumor that is clearly contaminated or a fluorescein. Here's the bulk of the tumor. Here's an additional piece of the tumor. Using neuronavigation data, we're just along the more of a posterolateral aspect of the tumor. Neuro fluorescein fluorescence also confirms the identity of that fragment as being tumorous. After tumor removal has been grossly completed using neuronavigation data you can see there's still small amount of nodules, or a few nodules especially close to the ventricle as you can appreciate here. And I'm going to go ahead and remove, and the biopsy of these specimens was consistent with tumor. Here, you can see those small nodules of the tumor that can be hiding along the walls of the cavity that can be pursued using fluorescein fluorescence and therefore resected. Here is the view of this part of the resection cavity under the YELLOW 560 module. This piece of enhancing tumor was also removed until clear margins was obtained. Here you can see the data corresponded to the walls of the resection cavity. At the end of our resection, further examination of resection cavity reveals essentially minimal to non fluorescence except this area that was subsequently also removed. You can see these tiny areas are most likely the cause of residual tumor normally without fluorescence. And post software MRI revealed gross total resection of the tumor. Thank you.

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