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Journal of Neurosurgical Sciences 2021 Oct 14

DOI: 10.23736/S0390-5616.21.05469-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Headlight and loupe-based fluorescein detection system in brain tumor surgery; a firstin-human experience

Xiaoran ZHANG 1, Ahmed HABIB 1, Emade JAMAN 2, Arka N. MALLELA 1, Nduka M. AMANKULOR 1, Pascal O. ZINN 1

1 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2 School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA


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BACKGROUND: Fluorescein is an agent that accumulates in areas of blood-brain barrier breakdown and is commonly used in neurosurgical oncology to assist with lesion localization and visualizing the extent of resection. It is considered to be cost-effective and has a favorable safety profile. Studies on the utilization of fluorescein demonstrate an improved extent of tumor resection and increased overall survival. Currently, fluorescein detection systems are all microscope based, leading to limitations such as decreased maneuverability, limited visualization of the entire operative field, and significant cost associated with obtaining and maintaining a neurosurgical operating microscope.
METHODS: Three consecutive craniotomy patients for tumor resection were included, and surgery was carried out under loupe fluorescence guidance using the ReVeal 450 System, and also a surgical microscope for comparison.
RESULTS: Loupe-mounted fluorescence system enabled excellent visualization of fluorescence in all three cases.
CONCLUSIONS: In this manuscript, we describe our experience with a loupe-mounted fluorescein detection system in 3 patients with malignant gliomas. We found that the loupe-mounted system offered excellent ability to visualize fluorescein fluorescence. Although loupe-mounted systems are not an alternative to surgical microscopes, they could be a useful surgical adjunct for superficial lesions and in low-middle income counties.


KEY WORDS: Fluorescein; Fluorescence; Tumor; Intraoperative visualization

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