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Technologie médicale
pour les professionnels de la santé
Maximiser la résection tumorale en préservant les zones fonctionnelles
Défi clinique
Trouver le juste équilibre entre préservation des zones fonctionnelles et résection maximale de la tumeur constitue un véritable défi, même pour les neurochirurgiens expérimentés. Les informations peropératoires sont donc indispensables pour prendre la bonne décision au bon moment.
La principale question est la suivante : des résidus tumoraux subsistent-ils ? [...] Si c'est le cas, il est important de les retirer sans détruire le cerveau sain, car, bien que nous ne puissions pas guérir les patients par chirurgie, l'étendue de la résection est néanmoins corrélée à la survie. [...] Au-delà de l'étendue de la résection, il en va aussi de la préservation des zones fonctionnelles.
Défis cliniques dans le traitement des tumeurs cérébrales
Visualiser
Identifier précisément les zones tumorales est cruciale, en particulier dans le cas des gliomes infiltrants1.
Il est donc essentiel de disposer d'une visualisation sous plusieurs angles de la région cible et des tissus importants adjacents pour réaliser une intervention dans de bonnes conditions2,3.
Contrôler
L'imagerie cellulaire in vivo en temps réel reste un défi en neurochirurgie. Il est pratiquement impossible d'éliminer chaque cellule de gliome par voie chirurgicale. Une résection encore plus précise des gliomes grâce à une délimitation plus claire des marges tumorales laisse présager de meilleurs résultats thérapeutiques4,5.
Traiter
Une radiothérapie du cerveau est normalement effectuée plusieurs semaines après une résection chirurgicale de la tumeur, ce qui laisse le temps à d'éventuelles cellules tumorales résiduelles de se développer.6 De plus, la radiothérapie conventionnelle présente actuellement un risque de dispersion du rayonnement qui peut conduire à une nécrose radiologique des tissus importants et entraîner des troubles neurocognitifs.7,8
Découvrez les avis cliniques de vos pairs sur MyZEISS
Ganslandt, Oliver
et autres.
Münter, Marc
et autres.
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Belykh E, et al. Progress in confocal laser endomicroscopy for neurosurgery and technical nuances for brain tumor imaging with fluorescein. Front Oncol 2019;9:554.
2
Schebesch K-M, et al. Clinical Benefits of Combining Different Visualization Modalities in Neurosurgery. Frontiers in Surgery 2019;6:56. DOI:10.3389/fsurg.2019.00056
3
Image de ZEISS BLUE 400 reproduite avec l'aimable autorisation du Prof. Dr Walter Stummer, Hôpital universitaire de Münster, Allemagne.
4
Belykh, E. et al. Blood-Brain Barrier, Blood-Brain Tumor Barrier, and Fluorescence-Guided Neurosurgical Oncology: Delivering Optical Labels to Brain Tumors. Fron Oncol 2020;10;739. https://www.frontiersin.org/article/10.3389/fonc.2020.00739. DOI=10.3389/fonc.2020.00739
5
Image confocale ZEISS CONVIVO ex vivo reproduite avec l'aimable autorisation du Dr med. Jürgen Schlegel, Université technique de Munich, Allemagne.
6
Cifarelli, C.P., et al. (2019). Intraoperative radiotherapy (IORT) for surgically resected brain metastases: Local control and dosimetric analysis. Journal of Global Oncology, 5(suppl1), 114
7
Vargo, J.A., et al. (2018). Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery. Journal of Neuro-Oncology, 140(2), 413–420.
8
Image d'application reproduite avec l'aimable autorisation du Dr med. Stefanie Brehmer, Faculté de médecine de Mannheim à l'Université de Heidelberg, Allemagne.
9
ZEISS Tumor Workflow est un concept qui comprend ZEISS KINEVO 900, ZEISS CONVIVO et ZEISS INTRABEAM 600.
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