The Application Of Fluorescein Sodium Combined With Contrast-enhanced Ultrasound In The Operation Of Intracranial Malignant Tumor

Objective:The present study is aim to explore the application value of Fluorescein Sodium combined with Contrast-Enhanced Ultrasound in the operation of intracranial malignant tumor.Clinical data and Methods:A retrospective analysis was performed on patients with intracranial malignant tumors in Neurosurgery of Jilin University China-Japan Union Hospital from September 2015 to July 2017.All patients enrolled were accept surgical treatment,in which Fluorescein Sodium and Contrast-Enhanced Ultrasound were applied.Inclusion criteria:(1)Intracranial malignant tumor Patients diagnosed by brain Magnetic Resonance Imaging.(2)Both Contrast-Enhanced Ultrasound and Fluorescein Sodium were applied to assist tumor removal under the microscope in the surgery of intracranial malignant tumor Patients.Exclusion criteria:(1)The Fluorescein Sodium test of patients was positive.(2)Severe medical diseases(heart disease,liver or kidney dysfunction).Instruments and medicines : The microscope was the OPMI PENTERO 900 with the YELLOW 560 fluorescent module.Fluorescent contrast agent was Fluorescein Sodium,trade name: Li She De,specification: 0.5ml: 0.5g(10%).Contrast-Enhanced Ultrasoundequipment was Esaote Mylab 90 Doppler ultrasound diagnostic apparatus,equipped with 5-10 MHz intraoperative ultrasound probe(Preoperative low temperature disinfection).Ultrasound contrast agent:Sulfur Hexafluoride Microbubbles for Injection,trade name:SonoVueSurgical methods : After general anesthesia of patients,inject Fluorescein Sodium 4mg / Kg(Preoperative test negative)via vein.The surgeon remove the bone flap and open the dura mater.The ultrasound probe was applicated in the bone window scan range,positioning the tumor to observe the tumor location,size,border and distance from the brain,the relationship with the functional area and so on.The color Doppler model was used to determine the relative position and relationship between the tumor tissue and the peripheral blood vessels.Then the ultrasound contrast agent was injected into the venae mediana cubiti.And begin to timing and recording immediately at the same time.Observing the perfusion and time of the tumor in real time to further identify the tumor boundary.Then the microscopic resection was performed under the fluorescence module.According to the situation under fluorescence,the tumor bodies were divided into yellow area and pink area.At the border of the tumor,they were divided into Pink area and white area.We definition the main tumor body as pathology A under the guidance of Fluorescein Sodium.At the border of the tumor,two pieces of Pink tissue were arbitrarily selected and defined as pathologyB.We examine the tumor cavity thoroughly confirm that there was no staining of Fluorescein Sodium,perform ultrasound and Contrast-Enhanced Ultrasound again,remove the suspicious tissue and sent pathology,which was defined as pathology C.After fluorescence and ultrasound to determine no clear abnormal tissue,we take two little organization in the tumor chamber,which was pathology D?Pathology as a gold standard to determine the accuracy of Fluorescein Sodium combined with Contrast-Enhanced Ultrasound on the border of intracranial malignancy Tumor ? The brain MRI conventional and enhancement was reexamined within 72 hours after the operation to determine whether the tumor was completely cut or not.vital signs,liver and kidney function are postoperative continuous monitored for 3 days and regular follow-up after operation.Observation target : Combined with postoperative pathological conditions,the intracranial tumor fluorescence staining and Contrast-Enhanced Ultrasound were retrospectively analyzed?(1)Imaging conditions of different intracranial tumors under fluorescence?(2)The judgement of Fluorescein Sodium combined with Contrast-Enhanced Ultrasound to the tumor border.(3)The Time to Start(TTS)and Time to Peak(TTP)of different intracranial tumors under Contrast-Enhanced Ultrasound.(4)The relationship of Contrast-Enhanced Ultrasound between yellow and pink tissue under fluorescence.(5)Postoperative adversereactions and laboratory test results of Fluorescein Sodium combined with Contrast-Enhanced Ultrasound?Results:1.We collect A total of 35 patients with complete data,including 20cases(57.1%)high grade glioma,7 cases(20.0%)low grade glioma,5cases(14.3%)metastatic carcinoma,1 cases(2.9 %)ependymoma,2cases(5.7%)lymphoma.6 cases(17.1%)under fluorescent showed pink,29 cases(82.9%)under fluorescent showed yellow?19 cases of high-grade glioma,2 cases of low-grade glioma,metastatic carcinoma,ependymoma and lymphoma were yellow,which accompanied by necrosis of the tumor center without yellow;cystic tumor capsule Liquid obvious yellow?2.The pathological positive rate of pink tissue at the border of 33 cases was 57.6%.After Contrast-Enhanced Ultrasound scanning,4 cases were found to have no fluorescence in the residual cavity of the tumor,and the suspicious enhanced tissue with Contrast-Enhanced Ultrasound was 75%.The positive rate of pathological examination was 75%.3.In the analysis of high-grade glioma and low-grade glioma,under the Contrast-Enhanced Ultrasound,the time to start(TTS)was 13.14 +1.50 S and 14.96 + 0.66 S,and time to peak(TTP)was 25.99 + 1.68 S and28.71 + 1.21 S respectively,the TTS and TTP of the low-grade glioma slower than the high-grade glioma,the difference was statisticallysignificant(P<0.05).During 20 High-grade glioma cases,19 cases was yellow;and 7 cases low-grade glioma,5 cases was pink.The difference was statistically significant(P <0.05).4.No postoperative adverse reactions in all patients,continuous monitoring of liver and kidney function for 3 days showed no significant abnormalities.Conclusion:1.Fluorescein Sodium can be applied to a variety of intracranial tumors,glioma,metastatic carcinoma,ependymoma,lymphoma biopsy,etc.2.Fluorescence mode was recommended to remove the pink tissue as much as possible3.Fluorescein Sodium guide can reduce the number of times of contrast-enhanced ultrasound,and Contrast-Enhanced Ultrasound can increase the detection of tumor tissue by Fluorescein Sodium and optimize the cortical approach,both of which complement each other intraoperatively.4.High-grade glioma and low-grade glioma are different under fluorescence,and the time to start and the time to peak of Contrast-Enhanced Ultrasound was different.