Chirurgia guidata dalla fluoresceina nella resezione di tumori del sistema nervoso centrale e periferico con filtro giallo a 560nm per il microscopio operatorio

Introduction: removal of the final part of a nervous system neoplasm carries the greatest impact from an oncological point of view. Fluorescence guided surgery leads to a better discrimination between pathological and heathy tissue and maximize the extent of resection of the tumor. Material and method: 38 patients underwent surgery in 2 different Institutions (Varese and Monza) after injection of 5mg/kg of Sodium Fluorescein at the induction of anesthesia. Surgery was performed with a dedicated blue and yellow filter for excitation and visualization of Fluorescein. Fluorescein intensity in RGB scale was evaluated in 311 images from intraoperative video with ImageJ software and a statistical analysis with Microsoft Excel was performed. The regions of interest were: inside the lesion, margins and healthy parenchyma. Results: Statistically significance was revealed in the G channel. The fluorescein intensity varied between the different pathological tissue. High cellularity lesions showed a high and inhomogeneous intensity (GBM, metastases, anaplastic glioma), meningiomas, neurocytomas, ependymomas and schwannomas showed a homogeneous moderate/ high fluorescein intensity. Conclusion: a G value threshold was evaluated at 167. Below this value we can postulate there are no malignant cells, or no cells (necrotic area). Further work is necessary to extrapolate significant B and R values and to evaluate differences between different histologies.