Chlorine E6 conditioned fluorescent navigation in glioma surgery

Fluorescent navigation in glioma surgery has been increasingly used in recent years. In most studies, 5-aminolevulinic acid derivatives (5ALA) are used as fluorescence inducers. Information in the literature regarding the use of drugs from the E6 chlorin group is rather scarce.

PURPOSE  OF THE   STUDY.  To evaluate the effectiveness and possibility of using fluorescent navigation with chlorin E 6 in glioma surgery.

MATERIALS  AND METHODS .  The study included 30 patients with glial tumors of varying degrees of malignancy according to Grade (II–IV). All patients were operated on at the RN hI named after N.N. prof. A.  L.  Polenov. For visual study of fluorescence, equipment was used in the form of a Leica OHS operating microscope, the d-Light AF System by Karl Storz (Germany), a fluorescent module of our own production (St.  Petersburg LOMO, developed by G. V.  Papayan) and special software RSS Cam — Endo 1.4.313. For the histological study of biopsy specimens, hematoxylin-eosin staining and immunohistochemical studies were taken.

RESULTS .  It was confirmed at the histological level that the fluorescence intensity was weak in all patients with Grade II gliomas and strong in almost all patients with Grade III–IV gliomas. The sensitivity of the method of fluorescent diagnostics with chlorin E6 for Grade  II gliomas was 72.2  %, for Grade III gliomas — 83.8   %, for Grade IV — 87.7  %. The  specificity of the method was 60  % for Grade II gliomas, 66.7  % for Grade III gliomas, and 85.2  % for Grade IV gliomas.

CONCLUSION.  The use of a certain fluorescent imaging system made it possible to resect glial brain tumors using chlorin E6, and the intensity of tumor fluorescence correlated with the grade of glioma malignancy.

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