悪性神経膠腫に対するFluorescein Naを用いた手術戦略

Surgical Strategy for Malignant Glioma Resection with Intraoperative Use of Fluorescein Na

Ⅰ．はじめに

　悪性神経膠腫に対する外科的切除率の生命予後改善に対する貢献度は，未だに議論の対象である ^2,3)．しかし画像上造影される病変は，細胞密度も高く血管増生も豊富なviableな病理組織像を呈し，少なくとも同部位の切除は理論上意味があると考えられる．また，画像上造影される病変の切除を悪性神経膠腫摘出術の指標としている施設は多いと思われる．われわれは確実な摘出術を達成するために，CT，MRI上で造影される悪性神経膠腫の摘出手術時にFluorescein Na（FNa）を用いた工夫を行ってきた．本稿では，FNaを用いた悪性神経膠腫の摘出術における方法論,注意点について概説する．

　Cytoreductive surgery is accepted by many neurosurgeons to be the best treatment for patients with malignant gliomas. Resection of a contrast-enhancing lesion on a CT or MR image is a particularly common treatment, because observation of such lesions indicates the presence of viable tumor cells. We have used intravenous injection of fluorescein Na (0.2cc/kg body weight) as a chemical probe for resection of malignant gliomas. Following this injection, the yellow-stained tumor is visible to the naked eye. For tumors located in an eloquent area, resection is performed at the surface of the yellow-stained tumor, or tumor debulking within the yellow-colored lesion is conducted until the resection surface becomes pale yellow. For tumors located in non-eloquent regions, suction of peritumoral white matter is also required. This procedure requires no special equipment and has wide applicability in resection of malignant gliomas.