A 55 years old gentleman was admitted in Neurology with complaints of recurrent seizures, right sided paralysis and speech disturbance. He was operated for brain tumor (Glioma) in 1996 and had received full course of radiotherapy then.
His imaging studies revealed a recurrent, large, diffuse and infiltrating tumour in the left fronto-parietal lobe of his brain. The tumour was involving eloquent areas of the brain like speech and right upper and lower limb.
One of the challenges in operating such tumours is that they are in-differentiable from normal brain tissue to naked eye making resection difficult without causing additional deficits.
In Glioma surgery, the extent of resection (EOR) is one important predictor of progression-free survival.
Sodium fluorescein (FL) is a fluorescent dye that was originally used for angiography in ophthalmic surgery. FL accumulates in areas of the disturbed blood-brain barrier and can be visualized under a 560-nm wavelength fluorescent light source (YELLOW 560 nm) A new microscope-integrated fluorescent module has been recently developed for fluorescein. We employed this technology to maximize resection of tumour. This state of the art technology is being used in very few centres in India.
Here, we present our experiences with low-dose FL and YELLOW 560 nm in this patient. Intra operatively we managed to maximise resection of tumour staying millimetres away from normal tissue. Post operatively patients’ symptoms did not improve due to brain edema but subsequently he improved and now comes for outpatient visits walking without support with significant improvement in speech.
In this fast-moving era of innovation, it is important to embrace cutting edge technology because in neurosurgery an error of millimeter can damage thousands of neurons.