Temporal GBM: Fluorescence Guidance

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Let's review another example of resection of glioblastoma multiforme, using fluorescein fluorescence-guidance. This is a 45 year-old male with subtle dysphasia who was known to a heterogeneously enhancing mass along the medial aspect of the left temporal lobe. The edema, and most likely some of the areas of the tumor involve the left insular. However, the nature of the enhancing areas were confined to the medial temporal lobe and this was the area of the surgical target. The position of the patient on the operating room table is illustrated. The incision is also marked, navigation was used. Following completion of the left temporal craniotomy, you can see the use of fluorescein fluorescence under yellow 516 module. The dura enhances. Here's the part of the tumor that reaches to surface of the temporal lobe. Again, this is anterior, this is posterior, and here is toward the middle fossa floor. The vein of lapel located here was protected. A corticotomy along the inferior temporal gyrus was completed, and the deeper portions of the tumor were identified. The tumor is easily identifiable due to it's contrast enhancement. I continued microdissection around the margin of the enhancement. Neuro-navigation also reassured me of the margins of the tumor. You can see, looks relatively normal in this area. However, under fluorescence, this proliferative area, which is non-necrotic can be very similar to the normal brain, but it's actually tumorous. This area was first debulked and then the enhancing areas were removed. You can see the corresponding areas of tumor under MRI navigation. The non-enhancing areas at the margin of the tumor are apparent. You can see the contrast between the tumor and the pre-tumoral areas. Here again, is another pull of the tumor. A contrast between the pre-tumoral area and the tumor. The last pieces of the tumor that can be left around the folds of the resection cavity are removed and the post-operative MRI revealed gross total removal of the enhancing part of the tumor. Thank you.

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