Maximierung der Tumorresektion bei gleichzeitiger Erhaltung eloquenter Bereiche
Klinische Herausforderung
Das richtige Gleichgewicht zwischen der Erhaltung funktionaler Bereiche und der großflächigen Resektion bei der Hirntumoroperation ist selbst für erfahrene Neurochirurgen eine Herausforderung. Intraoperative Informationen sind daher von unerlässlicher Bedeutung, damit die richtige Entscheidung zur richtigen Zeit getroffen werden kann.
Die wichtigste Frage ist: Ist da noch ein Teil des Tumors vorhanden? […] Und hier gilt das Prinzip der maximal sicheren Resektion, denn wir können [Patienten] nicht mit einem Eingriff vollständig heilen – doch der Umfang der Resektion korreliert mit der Überlebensrate. […] Es geht nicht nur um den Umfang der Resektion, sondern auch um die Bewahrung und Erhaltung der Funktion.
Klinische Herausforderungen bei der Behandlung von Hirntumoren
See
Die präzise Identifikation der Tumorbereiche ist unverzichtbar, insbesondere bei infiltrativen Gliomen.1
Die Grundlage einer sicheren Operation ist daher die vielseitige Visualisierung der Zielregion und des umliegenden eloquenten Gewebes.2,3
Check
Die zelluläre In-vivo-Bildgebung in Echtzeit ist nach wie vor eine Herausforderung in der Neurochirurgie. Es ist praktisch unmöglich, jede Gliomzelle operativ zu entfernen. Dabei prognostiziert eine höhere Präzision bei der Gliomentfernung mit genauerer Randabgrenzung bessere Behandlungsergebnisse.4,5
Treat
Mit einer Radiotherapie des Gehirns wird normalerweise erst mehrere Wochen nach der operativen Tumorentfernung begonnen. Eventuelle verbleibende Tumorzellen (Residualtumor) können bis dahin ggf. wieder nachwachsen.6 Die aktuelle und konventionelle Strahlentherapie birgt zudem das nicht zu vernachlässigende Risiko einer Streustrahlung, die zu einer Strahlennekrose im eloquenten Gewebe führen und neurokognitive Störungen hervorrufen kann.7,8
ZEISS Tumor Workflow
Der ZEISS Tumor Workflow9 kombiniert drei führende Technologien von ZEISS: Fortschrittlichste Visualisierung während der OP, In-vivo-Pathologie und intraoperative Strahlentherapie. Auf diese Weise unterstützt ZEISS multidisziplinäre Teams, unter anderem Neurochirurgen, Neuropathologen und Radioonkologen, in mehreren Schritten des operativen Workflows der Hirntumorbehandlung.
In dieser klinischen Fallstudie berichtet die Neurochirurgische Klinik der TU München über ihre ersten Erfahrungen bei der Integration der konfokalen Endomikroskopie und intraoperativen Strahlentherapie in ihre neurochirurgische Praxis und die Durchführung einer ersten Glioblastom-Behandlung mit diesen fortschrittlichen Technologien.
Bitte füllen Sie das Formular unten aus, um die Fallstudie zu erhalten. NB: Die Fallstudie ist ausschließlich auf Englisch erhältlich.
Klinische Fallstudie jetzt herunterladen
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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
Anwendungsspezifische Abbildung zu ZEISS BLUE 400 mit freundlicher Genehmigung von Prof. Dr. Walter Stummer, Universitätsklinikum Münster, Deutschland.
4
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
5
Konfokale Ex-vivo-Abbildung aus ZEISS CONVIVO mit freundlicher Genehmigung von Dr. med. Jürgen Schlegel, Technische Universität München, Deutschland.
6
Cifarelli, C.P., et al. (2019). Intraoperative radiotherapy (IORT) for surgically resected brain metastases: Local control and dosimetric analysis. Journal of Global Oncology, 5(suppl1), 114
7
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.
8
Anwendungsspezifische Abbildung mit freundlicher Genehmigung von Dr. med. Stefanie Brehmer, Medizinische Fakultät Mannheim der Universität Heidelberg, Deutschland.
9
Das Konzept des ZEISS Tumor Workflows setzt sich aus der Nutzung von ZEISS KINEVO 900, ZEISS CONVIVO und ZEISS INTRABEAM 600 zusammen.
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![Prof. Dr. Andreas Raabe, Chefarzt und Direktor]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/raabe.jpg/_jcr_content/renditions/original.image_file.100.100.48,0,575,527.file/raabe.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/raabe.jpg/_jcr_content/renditions/original.image_file.360.360.48,0,575,527.file/raabe.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/raabe.jpg/_jcr_content/renditions/original.image_file.527.527.48,0,575,527.file/raabe.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/raabe.jpg/_jcr_content/renditions/original.image_file.527.527.48,0,575,527.file/raabe.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/raabe.jpg/_jcr_content/renditions/original.image_file.527.527.48,0,575,527.file/raabe.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/raabe.jpg/_jcr_content/renditions/original.image_file.527.527.48,0,575,527.file/raabe.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/raabe.jpg/_jcr_content/renditions/original.image_file.527.527.48,0,575,527.file/raabe.jpg"} "Prof. Dr. Andreas Raabe, Chefarzt und Direktor")
![Visualisierung der Fluoreszenz]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/blue-400_robotic-visualization_system.jpg/_jcr_content/renditions/original.image_file.100.56.file/blue-400_robotic-visualization_system.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/blue-400_robotic-visualization_system.jpg/_jcr_content/renditions/original.image_file.360.203.file/blue-400_robotic-visualization_system.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/blue-400_robotic-visualization_system.jpg/_jcr_content/renditions/original.image_file.768.432.file/blue-400_robotic-visualization_system.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/blue-400_robotic-visualization_system.jpg/_jcr_content/renditions/original.image_file.1024.576.file/blue-400_robotic-visualization_system.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/blue-400_robotic-visualization_system.jpg/_jcr_content/renditions/original.image_file.1280.720.file/blue-400_robotic-visualization_system.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/blue-400_robotic-visualization_system.jpg/_jcr_content/renditions/original.image_file.1440.810.file/blue-400_robotic-visualization_system.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/blue-400_robotic-visualization_system.jpg/_jcr_content/renditions/original./blue-400_robotic-visualization_system.jpg"} "Visualisierung der Fluoreszenz")
![Kontrolle von Hirntumoren]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/6_clinical_challenge_check.jpg/_jcr_content/renditions/original.image_file.100.56.file/6_clinical_challenge_check.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/6_clinical_challenge_check.jpg/_jcr_content/renditions/original.image_file.360.203.file/6_clinical_challenge_check.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/6_clinical_challenge_check.jpg/_jcr_content/renditions/original.image_file.768.432.file/6_clinical_challenge_check.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/6_clinical_challenge_check.jpg/_jcr_content/renditions/original.image_file.1024.576.file/6_clinical_challenge_check.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/6_clinical_challenge_check.jpg/_jcr_content/renditions/original.image_file.1280.720.file/6_clinical_challenge_check.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/6_clinical_challenge_check.jpg/_jcr_content/renditions/original.image_file.1440.810.file/6_clinical_challenge_check.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/6_clinical_challenge_check.jpg/_jcr_content/renditions/original./6_clinical_challenge_check.jpg"} "Kontrolle von Hirntumoren")
![Behandlung von Hirntumoren]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/4_clinical_challenge_treat.jpg/_jcr_content/renditions/original.image_file.100.56.file/4_clinical_challenge_treat.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/4_clinical_challenge_treat.jpg/_jcr_content/renditions/original.image_file.360.203.file/4_clinical_challenge_treat.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/4_clinical_challenge_treat.jpg/_jcr_content/renditions/original./4_clinical_challenge_treat.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/4_clinical_challenge_treat.jpg/_jcr_content/renditions/original./4_clinical_challenge_treat.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/4_clinical_challenge_treat.jpg/_jcr_content/renditions/original./4_clinical_challenge_treat.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/4_clinical_challenge_treat.jpg/_jcr_content/renditions/original./4_clinical_challenge_treat.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/reference-master/specialties/neurosurgery/tumor-resection/images/4_clinical_challenge_treat.jpg/_jcr_content/renditions/original./4_clinical_challenge_treat.jpg"} "Behandlung von Hirntumoren")
![ZEISS Tumor Workflow]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.100.50.0,5,1380,695.file/stagebg_tumor.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.360.180.0,5,1380,695.file/stagebg_tumor.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.768.384.0,5,1380,695.file/stagebg_tumor.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.1024.512.0,5,1380,695.file/stagebg_tumor.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.1280.640.0,5,1380,695.file/stagebg_tumor.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.1380.690.0,5,1380,695.file/stagebg_tumor.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.1380.690.0,5,1380,695.file/stagebg_tumor.jpg"} "ZEISS Tumor Workflow")
![ZEISS Tumor Workflow]({"xsmall":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.100.100.680,0,1380,700.file/stagebg_tumor.jpg","small":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.360.360.680,0,1380,700.file/stagebg_tumor.jpg","medium":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.700.700.680,0,1380,700.file/stagebg_tumor.jpg","large":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.700.700.680,0,1380,700.file/stagebg_tumor.jpg","xlarge":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.700.700.680,0,1380,700.file/stagebg_tumor.jpg","xxlarge":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.700.700.680,0,1380,700.file/stagebg_tumor.jpg","max":"https://www.zeiss.com/content/dam/med-hcp/international/campaigns/worldcancerday/stagebg_tumor.jpg/_jcr_content/renditions/original.image_file.700.700.680,0,1380,700.file/stagebg_tumor.jpg"} "ZEISS Tumor Workflow")
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