CLINICAL CHALLENGES IN BRAIN TUMOR TREATMENT

Maximum brain tumor resection

- Clinical Challenge

- ZEISS Solution

- Peer Insights

CLINICAL CHALLENGE

Maximizing tumor resection while preserving eloquent areas

Finding the balance between preserving functional areas and extending resection during brain tumor surgery is a challenge even for experienced neurosurgeons. Therefore, intraoperative information is critical to be able to make the right decision at the right time.


Andreas Raabe, MD, Professor, Director and Head Physician Department of Neurosurgery, University Bern, Switzerland

The main question is: Is there still tumor? […] And here maximum safe resection is the principle because we cannot cure them by surgery and still the extent of resection correlates with survival. […] It is not only the extent of resection but also the maintenance and the preservation of function.

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Tumor workflow challenges

Visualization of fluorescence-stained structures using BLUE 4001 during glioma surgery A

See

Precise identification of tumor areas is crucial, particularly in the case of infiltrative gliomas.1
Therefore, the foundation of a safe surgery is the multifaceted visualization of the target region and the surrounding eloquent tissue.2

B

Check

In vivo cellular imaging in real-time remains a challenge in neurosurgery. It is practically impossible to remove every glioma cell surgically. Increasing the precision of glioma removal with more accurate margin delineation predicts better treatment outcomes.3

C

Treat

Radiotherapy in the brain is normally done several weeks after the surgical tumor removal which enables potential residual tumor cells to regrow by then.4 In addition, conventional radiotherapy today has a certain risk of irradiation scattering which can lead to radiation necrosis of eloquent tissue and result in neurocognitive failures.5

  • 1 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 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
  • 4 Cifarelli, C.P., etal. (2019). Intraoperative radiotherapy (IORT) for surgically resected brain metastases: Local control and dosimetric analysis. Journal of Global Oncology, 5(suppl1), 114
  • 5 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.
ZEISS Solution

Reconsider the standard of care in brain tumor treatment combining three leading technologies

The ZEISS Tumor Workflow6,7 provides the latest technologies to support neurosurgeons to improve brain tumor treatment and combines three leading technologies from ZEISS: Surgical visualization using navigation-guided surgeon-controlled robotic alignment, real-time feedback on tissue microstructure through digital consultation with a pathologist, and intraoperative radiotherapy. In doing so, ZEISS supports intraoperative teams over several steps of the surgical workflow in delivering brain tumor treatment.

6 The ZEISS Tumor Workflow is a concept that includes the ZEISS KINEVO 900, ZEISS CONVIVO and ZEISS INTRABEAM 600.
7 ZEISS CONVIVO is 510(k) pending, not available for sale within the USA. Please use the respective fluorescence agent as per the approval status of the application in your country.  

PART OF THE ZEISS MEDICAL ECOSYSTEM
ZEISS Tumor Workflow

See.

Visualization of small and fluorescence-stained structures during tumor treatment
Visualization of small and fluorescence-stained structures during tumor treatment
ZEISS KINEVO 900
ZEISS QEVO

The powerful Robotic Visualization System® KINEVO® 900 from ZEISS delivers unparalleled real-time insights with

  • Surgeon-Controlled Robotics
  • Digital Hybrid Visualization
  • QEVO® – The Micro-Inspection Tool

Check.

Real-time feedback on tissue microstructure through digital pathology consultation
Real-time feedback on tissue microstructure through digital pathology consultation
ZEISS CONVIVO

The In Vivo Pathology Suite CONVIVO® from ZEISS includes the Surgical Workplace and the Pathology Workplace enabling to share in vivo cellular images with cross-functional medical team members during surgery to

  • visualize tissue microstructure in real-time.
  • check a virtually unlimited number of samples in situ.
  • transfer and analyze digital images – anytime anywhere.

Treat.

Precise targeting and intraoperative irradiation of the tumor cavity during surgery
Precise targeting and intraoperative irradiation of the tumor cavity during surgery
ZEISS INTRABEAM 600
ZEISS INTRABEAM 600 Applicator

The Multi-application IORT Treatment Platform INTRABEAM® 600 from ZEISS enables immediate intraoperative radiotherapy in the OR and differentiates from conventional radiotherapy options

  • by Local Precision, relevant for tumor bed sterilization and sparing organs at risk
  • as Time Matters, relevant for preventing tumor reformation and shorter treatment courses
  • by Proven Performance, relevant for personalized and evidence-based treatments

Peer insights

Clinical experiences with ZEISS Tumor Workflow

Intradisciplinary therapy of brain tumors

Read article

Neurosurgical workflow for patients with brain tumors

Read article

Intraoperative radiotherapy for CNS tumors

Read article
See all articles

First impressions of ZEISS Tumor Workflow

See.

International experts share their first impressions on ZEISS QEVO – The Micro-Inspection Tool.

Check.

First customer impressions on potentials of digital pathology consultation in neurosurgery.

Treat.

Peer insights of Dr. Giordano on IORT in the Neuro setting. Personal experiences of Glioblastoma treatments also within the INTRAGO trial, challenges to overcome, patient aspects and teamwork.

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  • 1 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 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
  • 4 Cifarelli, C.P., etal. (2019). Intraoperative radiotherapy (IORT) for surgically resected brain metastases: Local control and dosimetric analysis. Journal of Global Oncology, 5(suppl1), 114
  • 5 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.
  • 6 The ZEISS Tumor Workflow is a concept that includes the ZEISS KINEVO 900, ZEISS CONVIVO and ZEISS INTRABEAM 600.
  • 7 ZEISS CONVIVO is 510(k) pending, not available for sale within the USA. Please use the respective fluorescence agent as per the approval status of the application in your country.

Image courtesies:
A: The application image of ZEISS BLUE 400 is courtesy of Prof. Dr. Walter Stummer, University Clinic, Munich, Germany.
B: The ZEISS CONVIVO ex vivo confocal image is courtesy of Dr. med. Jürgen Schlegel, Technical University Munich, Germany.
C: The application image is courtesy of Dr. med. Stefanie Brehmer, Mannheim Medical Faculty at University of Heidelberg, Germany.