Tecnologie di fluorescenza intraoperatoria ZEISS
Riuscire a vedere quello che prima era invisibile
La fluorescenza è la proprietà di atomi e molecole, i cosiddetti fluorofori, di assorbire luce a una particolare lunghezza d’onda e di emettere successivamente luce di lunghezza d’onda maggiore. La microscopia a fluorescenza può basarsi sull’autofluorescenza o sull’aggiunta di coloranti fluorescenti.1,2 Alla luce normale i coloranti fluorescenti possono essere invisibili. Ma un microscopio operatorio con tecnologia di fluorescenza integrata illumina il colorante per visualizzare il tessuto tumorale o i vasi sanguigni durante l’intervento.
Il primo utilizzo dell’imaging intraoperatorio a fluorescenza in chirurgia risale al 1948, quando i chirurghi iniziarono ad utilizzare la fluoresceina per via endovenosa al fine di migliorare le neoplasie intracraniche durante la neurochirurgia.2,9 Da allora, altri agenti fluorescenti sono stati utilizzati per diverse applicazioni chirurgiche.4,5,6,9 L’imaging intraoperatorio a fluorescenza ha i vantaggi di un elevato contrasto e sensibilità, assenza di radiazioni ionizzanti, facilità d’uso, sicurezza ed elevata specificità.7,8,9 Rispetto alla visione standard non assistita che utilizza l’imaging a luce bianca, l’imaging a fluorescenza in tempo reale è utile per visualizzare il tessuto canceroso e delineare i margini del tumore.8 Inoltre, una migliore visualizzazione del tumore può ridurre i danni a importanti strutture normali come nervi, vasi sanguigni, ureteri e dotti biliari.9
Nella microchirurgia più impegnativa, gli ausili per la visualizzazione chirurgica sono essenziali per prendere le decisioni giuste al momento giusto. Le tecnologie di fluorescenza intraoperatoria1 di ZEISS offrono gli strumenti necessari.
Visualizzazione intraoperatoria di strutture colorate a fluorescenza in chirurgia oncologica
Visualizzazione intraoperatoria di strutture colorate a fluorescenza in chirurgia oncologica
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BLUE 400 di ZEISS
BLUE 400 di ZEISS supporta la differenziazione intraoperatoria tra tessuto malato e tessuto sano. È stato l’unico modulo di fluorescenza integrato nel microscopio a dimostrare la propria efficienza in uno studio multicentrico di fase III condotto con successo.2
Secondo uno studio del 2015 di Esteves et al. i gliomi di alto grado (gradi III-IV) sono i tumori cerebrali più comuni in Europa, con un’incidenza di 3,13 per 100.000 abitanti. L’estensione della resezione del tumore è un fattore prognostico importante per la sopravvivenza.3 Gli studi dimostrano che la resezione di almeno il 98% del tessuto tumorale è necessaria per avere un impatto significativo sul tasso di sopravvivenza. Uno studio randomizzato e controllato (RCT) condotto da Stummer et al. nel 2006 ha dimostrato che la probabilità di resezione completa del tumore è significativamente aumentata con l’uso della fluorescenza 5-ALA (acido 5-aminolevulinico) (65% vs. 37%, p<0,0001).2
Abbiamo [...] pubblicato uno studio medico-economico [...] per dimostrare che [utilizzando] BLUE 400, possiamo migliorare l’esito dei trattamenti sui pazienti [...].
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Resezione del glioblastoma di alto grado guidata dalla fluorescenza
Prof. Dr. Andreas Raabe
Direttore e Capo del Dipartimento di Neurochirurgia, Inselspital di Berna, Svizzera
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ZEISS YELLOW 560
ZEISS YELLOW 560 è il primo modulo di fluorescenza intraoperatorio1 che mette in evidenza le strutture colorate in fluorescenza, visualizzando al tempo stesso i tessuti non colorati nel loro colore naturale. Permette di svolgere attività di ricerca con coloranti a fluorescenza adeguati.1
Il vantaggio è che il tumore viene resecato in modo migliore perché la parte di cervello non colpita viene visualizzata indirettamente e può essere conservata.
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Resezione del glioblastoma guidata dalla fluorescenza
Prof. Dr. Karl-Michael Schebesch e Dr. Julius Höhne
Clinica e Policlinico di Neurochirurgia, Ospedale Universitario di Ratisbona, Germania
Constantinos G Hadjipanayis,
Jeffrey N Bruce,
John YK Lee
1
Utilizzare l’agente fluorescente come da stato di omologazione per l’applicazione nel proprio paese.
2
Stummer W, Pichlmeier U, Meinel T et al: Fluorescence-guided surgery for resection of malignant glioma: a randomized controlled multicentre phase III trial. In: Lancet Oncol 7: 392-401, 2006.
3
Esteves S, Alves M, Castel-Branco M, Stummer W: A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminoelvulinic Acid Compared With White-Light Surgery. In: Neurosurgery 76: 552–562, 2015.
4
Acerb Fi, Cavallo C, Schebesch KM, et al.: Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors: Results from a Preliminary, Multicentric, Retrospective Study. In: World Neurosurgery 108: 603-609, 2017.
5
Rey-Dios R, Cohen-Gadol AA: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. In: Acta Neurochirurgica 155(4):701–706, 2013.
6
De Laurentis C, Höhne J, Cavallo C, et al.: The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study. In: Journal of Neurosurgical Sciences 63(6): 679-687, 2019.
7
Acerbi F, Broggi M, Schebesch KM, et al. Fluorescein-guided surgery for resection of high-grade gliomas: A multicentric prospective phase II study (FLUOGLIO). In: Clinical Cancer Research 24(1): 52-61, 2018.
8
Schebesch KM, Proescholdt M, Höhne J, et al.: Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery – a feasibility study. In: Acta Neurochirurgica 157(6): 899–904, 2015.
9
Höhne J, Hohenberger C, Proescholdt M, et al. Fluorescein sodium-guided resection of cerebral metastases-an update. In: Acta Neurochirurgica 159: 363-367, 2017.
10
Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V: Near-Infrared Indocyanine Green Video Angiography: A New Method For Intraoperative Assessment Of Vascular Flow. In: Neurosurgery 52(1):132-139, 2003.
11
Raabe A, Beck J, Seifert V: Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. In: Zentralbl Neurochir 66(1):1–6, 2005.
12
Kamp MA, Slotty P, Turowski B, Etminan N, Steiger HJ, Hänggi D, Stummer W: Microscope-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: first experience in 30 patients. In: Operative Neurosurgery 70(1 Suppl Operative): 65-73, 2012.
13
Mücke T, Reeps C, Wolff KD, et al.: Objective qualitative and quantitative assessment of blood flow with near-infrared angiography in microvascular anastomoses in the rat model. In: Microsurgery 33(4):287-96, 2013.
14
Ye X, Liu XJ, Ma L, et al.: Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery. In: Chinese Medical Journal 126(22): 4232-4237, 2013.
15
Holling M, Brokinkel B, Ewelt C, et al.: Dynamic ICG fluorescence provides better intraoperative understanding of arteriovenous fistulae. In: Operative Neurosurgery 73(Issue suool_1): 93-99, 2013.
16
Ng YP, King NK, Wan KR, et al.: Uses and limitations of indocyanine green videoangiography for flow analysis in arteriovenous malformation surgery. In: Journal of Clinical Neuroscience 20(2): 224-232, 2013.
17
Holzbach T, Artunian N, Spanholtz TA, et al.: Intraoperative Indocyaningrün-Fluoreszenzdiagnostik mittels Operationsmikroskop in der plastischen Chirurgie. In: Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie 44(2):84-8, 2012.
18
Mücke T, Fichter AM, Schmidt LH, et al.: Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using FLOW® 800 Tool. In: Microsurgery 37:235–242, 2017.
19
Mücke T, Wolff C, Fichter AM, et al.: Detection of thrombosis in microvessels with8 indocyanine green videoangiography. In: British Journal of Oral and Maxillofacial Surgery 56(8): 678-683, 2018.
20
Yamato T, Yamamoto N, Numahata T, et al.: Navigation Lymphatic Supermicrosurgery for the Treatment of Cancer-Related Peripheral Lymphedema. In: Vascular and Endovascular Surgery 48(2):139-143, 2014.
21
Höhne J, Schebesch KM, de Laurentis C, Akçakaya MO, Pedersen CB, Brawanski A, Poulsen FR, Kiris T, Cavallo C, Broggi M, Ferroli P, Acerbi F Fluorescein Sodium in the Surgical Treatment of Recurrent Glioblastoma Multiforme. World Neurosurg. 2019 May;125:E158-E164. Epub 2019 Jan 22.
22
Stage image: left-temporal craniotomy for tumor resection with YELLOW 560. Immagine per gentile concessione del Dr. Peter Nakaji, Barrow Neurological Institute, Phoenix, Arizona, USA
Imaging intraoperatorio del flusso sanguigno cerebrale nella chirurgia vascolare
Imaging intraoperatorio del flusso sanguigno cerebrale nella chirurgia vascolare
ZEISS INFRARED 800
Con ZEISS INFRARED 800 è possibile visualizzare vasi sanguigni submillimetrici. L’imaging intraoperatorio del flusso sanguigno cerebrale è di particolare interesse nella neurochirurgia vascolare. L’angiografia assistita da fluorescenza con verde indocianina (ICG) consente di valutare qualitativamente in tempo reale la permeabilità vascolare o le strutture vascolari patologiche durante l’intervento chirurgico. Già nel 2003, i risultati di uno studio di fattibilità condotto da Raabe et al. hanno rivelato che l’angiografia a fluorescenza ICG è utile nella valutazione di aneurismi, fistole durali e nella chirurgia di rivascolarizzazione.10 Integrata nel microscopio operatorio, l’angiografia ICG è una tecnica adatta per la visualizzazione e per l’assistenza nella valutazione e nell’interpretazione del flusso sanguigno intraoperatorio nei vasi con diametro inferiore a 1 mm. Contribuisce alla diagnosi precoce delle complicanze e riduce il rischio di danno ischemico e la necessità di ulteriori interventi post-operatori.11
INFRARED 800 ha cambiato la pratica della neurochirurgia vascolare in sala operatoria. Ci ha permesso di rispondere realmente alle domande critiche dopo il clippaggio o dopo un bypass [...]. Ha facilitato le operazioni, le ha accorciate e ha quasi eliminato la necessità di un’angiografia intraoperatoria.
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ZEISS FLOW 800
Utilizzando le sequenze video di ZEISS INFRARED 800, ZEISS FLOW 800 offre un’applicazione di fluorescenza unica per l’analisi visiva del flusso sanguigno vascolare. Le informazioni ricavate dalle sequenze video vengono raccolte in mappe visive, diagrammi o immagini affiancate. Ciò consente un’analisi dettagliata dei video di fluorescenza.
Il semplice imaging delle strutture vascolari è spesso insufficiente per rilevare l’ipo o l’iperperfusione; per farlo è necessaria un’analisi quantitativa dei dati.12 I risultati degli studi hanno dimostrato che il software di analisi FLOW 800 fornisce preziose informazioni aggiuntive ai chirurghi nella valutazione intraoperatoria della pervietà arteriosa e del flusso sanguigno regionale.13-16
FLOW 800 è un importante strumento di visualizzazione e analisi nella chirurgia delle MAV, perché ci aiuta a comprendere molto rapidamente l’emodinamica di una MAV. Lavoro con FLOW 800 da diversi anni [...], ritengo che sia diventato indispensabile.
Ottieni contenuti didattici esclusivi, contenuti peer-to-peer, materiale per i pazienti e accesso a strumenti per gestire le tue attività quotidiane.
1
Utilizzare l’agente fluorescente come da stato di omologazione per l’applicazione nel proprio paese.
2
Stummer W, Pichlmeier U, Meinel T et al: Fluorescence-guided surgery for resection of malignant glioma: a randomized controlled multicentre phase III trial. In: Lancet Oncol 7: 392-401, 2006.
3
Esteves S, Alves M, Castel-Branco M, Stummer W: A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminoelvulinic Acid Compared With White-Light Surgery. In: Neurosurgery 76: 552–562, 2015.
4
Acerb Fi, Cavallo C, Schebesch KM, et al.: Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors: Results from a Preliminary, Multicentric, Retrospective Study. In: World Neurosurgery 108: 603-609, 2017.
5
Rey-Dios R, Cohen-Gadol AA: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. In: Acta Neurochirurgica 155(4):701–706, 2013.
6
De Laurentis C, Höhne J, Cavallo C, et al.: The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study. In: Journal of Neurosurgical Sciences 63(6): 679-687, 2019.
7
Acerbi F, Broggi M, Schebesch KM, et al. Fluorescein-guided surgery for resection of high-grade gliomas: A multicentric prospective phase II study (FLUOGLIO). In: Clinical Cancer Research 24(1): 52-61, 2018.
8
Schebesch KM, Proescholdt M, Höhne J, et al.: Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery – a feasibility study. In: Acta Neurochirurgica 157(6): 899–904, 2015.
9
Höhne J, Hohenberger C, Proescholdt M, et al. Fluorescein sodium-guided resection of cerebral metastases-an update. In: Acta Neurochirurgica 159: 363-367, 2017.
10
Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V: Near-Infrared Indocyanine Green Video Angiography: A New Method For Intraoperative Assessment Of Vascular Flow. In: Neurosurgery 52(1):132-139, 2003.
11
Raabe A, Beck J, Seifert V: Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. In: Zentralbl Neurochir 66(1):1–6, 2005.
12
Kamp MA, Slotty P, Turowski B, Etminan N, Steiger HJ, Hänggi D, Stummer W: Microscope-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: first experience in 30 patients. In: Operative Neurosurgery 70(1 Suppl Operative): 65-73, 2012.
13
Mücke T, Reeps C, Wolff KD, et al.: Objective qualitative and quantitative assessment of blood flow with near-infrared angiography in microvascular anastomoses in the rat model. In: Microsurgery 33(4):287-96, 2013.
14
Ye X, Liu XJ, Ma L, et al.: Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery. In: Chinese Medical Journal 126(22): 4232-4237, 2013.
15
Holling M, Brokinkel B, Ewelt C, et al.: Dynamic ICG fluorescence provides better intraoperative understanding of arteriovenous fistulae. In: Operative Neurosurgery 73(Issue suool_1): 93-99, 2013.
16
Ng YP, King NK, Wan KR, et al.: Uses and limitations of indocyanine green videoangiography for flow analysis in arteriovenous malformation surgery. In: Journal of Clinical Neuroscience 20(2): 224-232, 2013.
17
Holzbach T, Artunian N, Spanholtz TA, et al.: Intraoperative Indocyaningrün-Fluoreszenzdiagnostik mittels Operationsmikroskop in der plastischen Chirurgie. In: Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie 44(2):84-8, 2012.
18
Mücke T, Fichter AM, Schmidt LH, et al.: Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using FLOW® 800 Tool. In: Microsurgery 37:235–242, 2017.
19
Mücke T, Wolff C, Fichter AM, et al.: Detection of thrombosis in microvessels with8 indocyanine green videoangiography. In: British Journal of Oral and Maxillofacial Surgery 56(8): 678-683, 2018.
20
Yamato T, Yamamoto N, Numahata T, et al.: Navigation Lymphatic Supermicrosurgery for the Treatment of Cancer-Related Peripheral Lymphedema. In: Vascular and Endovascular Surgery 48(2):139-143, 2014.
21
Höhne J, Schebesch KM, de Laurentis C, Akçakaya MO, Pedersen CB, Brawanski A, Poulsen FR, Kiris T, Cavallo C, Broggi M, Ferroli P, Acerbi F Fluorescein Sodium in the Surgical Treatment of Recurrent Glioblastoma Multiforme. World Neurosurg. 2019 May;125:E158-E164. Epub 2019 Jan 22.
22
Stage image: left-temporal craniotomy for tumor resection with YELLOW 560. Immagine per gentile concessione del Dr. Peter Nakaji, Barrow Neurological Institute, Phoenix, Arizona, USA
Imaging intraoperatorio a fluorescenza nella chirurgia ricostruttiva
Imaging intraoperatorio a fluorescenza nella chirurgia ricostruttiva
Contenuto di parti terze bloccato
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Video esemplificativo dell’uso di INFRARED 800 nell’esame di un’anastomosi linfovenosa. Per gentile concessione del PD Dr. Christian Taeger, Medico Responsabile Senior del Dipartimento di Chirurgia Plastica, della Mano e Ricostruttiva, Ospedale Universitario di Ratisbona, Germania.
ZEISS INFRARED 800
Tipicamente utilizzato nella chirurgia dei lembi liberi, INFRARED 800 di ZEISS consente di valutare con la fluorescenza il flusso sanguigno dopo la creazione di un’anastomosi e di visualizzare la pervietà vascolare del tessuto innestato.
Uno studio del 2012 di Holzbach et al.17 dimostra che l’angiografia a fluorescenza ICG è una procedura utile, rapida e sicura nella chirurgia dei lembi, soprattutto nell’uso intraoperatorio. I risultati di Mücke et al. dimostrano che FLOW 800 costituisce uno strumento di analisi affidabile per il monitoraggio intraoperatorio della perfusione del lembo18 e per il rilevamento della trombosi intraoperatoria.19 Uno studio del 2014 di Yamamoto et al.20 ha rilevato che la linfografia ICG intraoperatoria facilita l’identificazione dei vasi linfatici e consente una valutazione accurata delle anastomosi.
L’integrazione della tecnologia di fluorescenza nel microscopio operatorio offre al chirurgo maggiore sicurezza e certezza in situazioni clinicamente ambigue durante l’esecuzione dell’intervento. Le anomalie del flusso sanguigno possono essere individuate rapidamente e gli interventi chirurgici necessari possono essere avviati immediatamente. Il metodo può prevedere con maggior successo la guarigione senza complicazioni di innesti cutanei e tissutali e fornire indicazioni iniziali di trombosi.
Contenuto di parti terze bloccato
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Per gentile concessione del Prof. Dr. Milomir Ninkovic, Capo del Dipartimento di Chirurgia Plastica e Ricostruttiva, della Mano e delle Ustioni, Clinica Universitaria Bogenhausen.
Il video esemplificativo mostra l’uso di INFRARED 800 nel controllo del flusso sanguigno dopo l’anastomosi.
Utilizzare l’agente fluorescente come da stato di omologazione per l’applicazione nel proprio paese.
2
Stummer W, Pichlmeier U, Meinel T et al: Fluorescence-guided surgery for resection of malignant glioma: a randomized controlled multicentre phase III trial. In: Lancet Oncol 7: 392-401, 2006.
3
Esteves S, Alves M, Castel-Branco M, Stummer W: A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminoelvulinic Acid Compared With White-Light Surgery. In: Neurosurgery 76: 552–562, 2015.
4
Acerb Fi, Cavallo C, Schebesch KM, et al.: Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors: Results from a Preliminary, Multicentric, Retrospective Study. In: World Neurosurgery 108: 603-609, 2017.
5
Rey-Dios R, Cohen-Gadol AA: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. In: Acta Neurochirurgica 155(4):701–706, 2013.
6
De Laurentis C, Höhne J, Cavallo C, et al.: The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study. In: Journal of Neurosurgical Sciences 63(6): 679-687, 2019.
7
Acerbi F, Broggi M, Schebesch KM, et al. Fluorescein-guided surgery for resection of high-grade gliomas: A multicentric prospective phase II study (FLUOGLIO). In: Clinical Cancer Research 24(1): 52-61, 2018.
8
Schebesch KM, Proescholdt M, Höhne J, et al.: Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery – a feasibility study. In: Acta Neurochirurgica 157(6): 899–904, 2015.
9
Höhne J, Hohenberger C, Proescholdt M, et al. Fluorescein sodium-guided resection of cerebral metastases-an update. In: Acta Neurochirurgica 159: 363-367, 2017.
10
Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V: Near-Infrared Indocyanine Green Video Angiography: A New Method For Intraoperative Assessment Of Vascular Flow. In: Neurosurgery 52(1):132-139, 2003.
11
Raabe A, Beck J, Seifert V: Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. In: Zentralbl Neurochir 66(1):1–6, 2005.
12
Kamp MA, Slotty P, Turowski B, Etminan N, Steiger HJ, Hänggi D, Stummer W: Microscope-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: first experience in 30 patients. In: Operative Neurosurgery 70(1 Suppl Operative): 65-73, 2012.
13
Mücke T, Reeps C, Wolff KD, et al.: Objective qualitative and quantitative assessment of blood flow with near-infrared angiography in microvascular anastomoses in the rat model. In: Microsurgery 33(4):287-96, 2013.
14
Ye X, Liu XJ, Ma L, et al.: Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery. In: Chinese Medical Journal 126(22): 4232-4237, 2013.
15
Holling M, Brokinkel B, Ewelt C, et al.: Dynamic ICG fluorescence provides better intraoperative understanding of arteriovenous fistulae. In: Operative Neurosurgery 73(Issue suool_1): 93-99, 2013.
16
Ng YP, King NK, Wan KR, et al.: Uses and limitations of indocyanine green videoangiography for flow analysis in arteriovenous malformation surgery. In: Journal of Clinical Neuroscience 20(2): 224-232, 2013.
17
Holzbach T, Artunian N, Spanholtz TA, et al.: Intraoperative Indocyaningrün-Fluoreszenzdiagnostik mittels Operationsmikroskop in der plastischen Chirurgie. In: Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie 44(2):84-8, 2012.
18
Mücke T, Fichter AM, Schmidt LH, et al.: Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using FLOW® 800 Tool. In: Microsurgery 37:235–242, 2017.
19
Mücke T, Wolff C, Fichter AM, et al.: Detection of thrombosis in microvessels with8 indocyanine green videoangiography. In: British Journal of Oral and Maxillofacial Surgery 56(8): 678-683, 2018.
20
Yamato T, Yamamoto N, Numahata T, et al.: Navigation Lymphatic Supermicrosurgery for the Treatment of Cancer-Related Peripheral Lymphedema. In: Vascular and Endovascular Surgery 48(2):139-143, 2014.
21
Höhne J, Schebesch KM, de Laurentis C, Akçakaya MO, Pedersen CB, Brawanski A, Poulsen FR, Kiris T, Cavallo C, Broggi M, Ferroli P, Acerbi F Fluorescein Sodium in the Surgical Treatment of Recurrent Glioblastoma Multiforme. World Neurosurg. 2019 May;125:E158-E164. Epub 2019 Jan 22.
22
Stage image: left-temporal craniotomy for tumor resection with YELLOW 560. Immagine per gentile concessione del Dr. Peter Nakaji, Barrow Neurological Institute, Phoenix, Arizona, USA
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Utilizzare l’agente fluorescente come da stato di omologazione per l’applicazione nel proprio paese.
2
Stummer W, Pichlmeier U, Meinel T et al: Fluorescence-guided surgery for resection of malignant glioma: a randomized controlled multicentre phase III trial. In: Lancet Oncol 7: 392-401, 2006.
3
Esteves S, Alves M, Castel-Branco M, Stummer W: A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminoelvulinic Acid Compared With White-Light Surgery. In: Neurosurgery 76: 552–562, 2015.
4
Acerb Fi, Cavallo C, Schebesch KM, et al.: Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors: Results from a Preliminary, Multicentric, Retrospective Study. In: World Neurosurgery 108: 603-609, 2017.
5
Rey-Dios R, Cohen-Gadol AA: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. In: Acta Neurochirurgica 155(4):701–706, 2013.
6
De Laurentis C, Höhne J, Cavallo C, et al.: The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study. In: Journal of Neurosurgical Sciences 63(6): 679-687, 2019.
7
Acerbi F, Broggi M, Schebesch KM, et al. Fluorescein-guided surgery for resection of high-grade gliomas: A multicentric prospective phase II study (FLUOGLIO). In: Clinical Cancer Research 24(1): 52-61, 2018.
8
Schebesch KM, Proescholdt M, Höhne J, et al.: Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery – a feasibility study. In: Acta Neurochirurgica 157(6): 899–904, 2015.
9
Höhne J, Hohenberger C, Proescholdt M, et al. Fluorescein sodium-guided resection of cerebral metastases-an update. In: Acta Neurochirurgica 159: 363-367, 2017.
10
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Stage image: left-temporal craniotomy for tumor resection with YELLOW 560. Immagine per gentile concessione del Dr. Peter Nakaji, Barrow Neurological Institute, Phoenix, Arizona, USA
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![ZEISS PENTERO 800 S]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/images/image_related_products_pentero800s.jpg/_jcr_content/renditions/original.image_file.100.100.file/image_related_products_pentero800s.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/images/image_related_products_pentero800s.jpg/_jcr_content/renditions/original.image_file.360.360.file/image_related_products_pentero800s.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/images/image_related_products_pentero800s.jpg/_jcr_content/renditions/original.image_file.768.768.file/image_related_products_pentero800s.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/images/image_related_products_pentero800s.jpg/_jcr_content/renditions/original./image_related_products_pentero800s.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/images/image_related_products_pentero800s.jpg/_jcr_content/renditions/original./image_related_products_pentero800s.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/images/image_related_products_pentero800s.jpg/_jcr_content/renditions/original./image_related_products_pentero800s.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/product-portfolio/surgical-microscopes/images/image_related_products_pentero800s.jpg/_jcr_content/renditions/original./image_related_products_pentero800s.jpg"} "ZEISS PENTERO 800 S")
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