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Resección máxima del tumor y preservación de las áreas funcionales
Reto clínico
Encontrar el equilibrio entre la conservación de las áreas funcionales y ampliar la resección durante la cirugía de tumores cerebrales es un desafío incluso para los neurocirujanos más experimentados. Por tanto, la información intraoperatoria es fundamental para poder tomar la decisión correcta en el momento adecuado.
La pregunta clave es: ¿todavía queda tumor? […] En caso afirmativo, seguimos el principio de resección máxima segura, ya que no es posible curar a través de la cirugía y, al mismo tiempo, la extensión de la resección correlaciona con la supervivencia. […] No solo importa el alcance de la resección, sino también el mantenimiento y la conservación de la función.
Retos clínicos en el tratamiento de tumores cerebrales
Visualizar
Es fundamental la identificación precisa de áreas tumorales, sobre todo en el caso de gliomas infiltrantes1.
Por tanto, la base para una cirugía segura es la visualización multifacética de la región objetivo y del tejido funcional circundante2,3.
Comprobar
Las imágenes celulares in vivo en tiempo real siguen siendo un desafío en neurocirugía. Es prácticamente imposible eliminar cada célula del glioma de forma quirúrgica. El aumento de la precisión de la resección del glioma con una delineación de márgenes más precisa predice mejores resultados del tratamiento4,5.
Tratar
La radioterapia en el cerebro normalmente se realiza varias semanas después de la resección quirúrgica del tumor, tiempo durante el cual las posibles células tumorales residuales pueden volver a crecer.6 Además, la radioterapia convencional actual presenta un cierto riesgo de dispersión de la irradiación, lo cual puede provocar una necrosis por radiación del tejido funcional y dar lugar a déficits cognitivos.7,8
ZEISS Tumor Workflow
ZEISS Tumor Workflow9 combina tres tecnologías líderes de ZEISS: Visualización quirúrgica avanzada, patología in vivo y radioterapia intraoperatoria. De este modo, ZEISS apoya a los equipos multidisciplinares, incluidos neurocirujanos, neuropatólogos y radiooncólogos, en varios pasos del flujo de trabajo quirúrgico para el tratamiento de tumores cerebrales.
Informe de caso clínico sobre el tratamiento de gioblastoma
En este informe de caso clínico, el Departamento de Neurocirugía de la Universidad Técnica de Múnich (Alemania) comparte sus primeras experiencias a la hora de integrar la endomicroscopía confocal y la radioterapia intraoperatoria a sus prácticas neuroquirúrgicas y de realizar un primer tratamiento de gioblastoma con estas tecnologías avanzadas.
Rellene el siguiente formulario para recibir el informe del caso: Tenga en cuenta que: el informe del caso solo está disponible en inglés.
¿Le gustaría descubrir más experiencias clínicas de sus colegas? Regístrese en MyZEISS para descubrir artículos clínicos y seminarios web adicionales en nuestra área Peer Insights.
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
La imagen de la aplicación de ZEISS BLUE 400 es cortesía del Prof. Dr. Walter Stummer, Clínica universitaria, Múnich, Alemania.
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
La imagen confocal ex vivo de ZEISS CONVIVO es cortesía del Dr. med. Jürgen Schlegel, Universidad Técnica de Múnich, Alemania.
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
La imagen de aplicación es cortesía de la Dra. med. Stefanie Brehmer, Facultad de Medicina de Mannheim de la Universidad de Heidelberg, Alemania.
9
ZEISS Tumor Workflow es un concepto que incluye ZEISS KINEVO 900, ZEISS CONVIVO y ZEISS INTRABEAM 600.
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