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Hiroya Ikeda, Yukitaka Ushio, Toru Hayakawa and Heitaro Mogami

animals were fixed in a prone position by a stereotaxic apparatus, ‡ and immobilized with pancuronium bromide. A volume respirator was used to maintain pO 2 between 90 and 140 mm Hg and pCO 2 between 30 and 35 mm Hg. Normal blood pressure was maintained by infusing Ringer's solution into the femoral vein. Laminectomy of four vertebrae centered at the level of tumor invasion was performed. After a single injection of 1 ml of 1% fluorescein sodium into the aorta through the catheter, serial fluorescein angiograms of the exposed spinal cord were taken without opening

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Shigeo Toya, Takeshi Kawase, Youichi Iisaka, Takanobu Iwata, Toshio Aki and Tsuneo Nakamura

repeating flash * was used for consecutive shooting of two exposures per second. An Asahi Bunko Kogakusha filter (420–485 mm) was set in front of the flash as an exciting filter, and a Kodak-Wratten No. 12 filter was set in front of the camera as a barrier filter. † After the photographic equipment had been assembled, 3 ml of fluorescein sodium solution (0.5%) was injected manually at a rapid rate via the polyethylene tube inserted in the common carotid artery. Consecutive shooting was commenced as the injection began, and a total of 36 photographs was taken. After

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Jun Shinoda, Hirohito Yano, Shin-Ichi Yoshimura, Ayumi Okumura, Yasuhiko Kaku, Toru Iwama and Noboru Sakai

systems, neurofunctional imaging, and intraoperative neurophysiological monitoring have increased the rate of radical tumor resection even in patients with GBMs. Achieving GTR of a GBM is actually difficult in some cases, however, because of the lesion's biological properties; that is, the border between tumor tissue and normal brain tissue cannot be recognized with the naked eye during surgery because of tumor cell infiltration. We have recently used a fluorescence-guided tumor resection procedure with the aid of high-dose fluorescein sodium and no special surgical

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Harry V. Vinters Cynthia Cabatan-Awang Robert E. Wallace Timothy D. Solberg September 2003 99 3 591 596 10.3171/jns.2003.99.3.0591 Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium Jun Shinoda Hirohito Yano Shin-Ichi Yoshimura Ayumi Okumura Yasuhiko Kaku Toru Iwama Noboru Sakai September 2003 99 3 597 603 10.3171/jns.2003.99.3.0597 A device for cooling localized regions of human cerebral cortex Hans E. Bakken Hiroto Kawasaki Hiroyuki

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Yoji Tamura, Toshihiko Kuroiwa, Yoshinaga Kajimoto, Yoshihito Miki, Shin-Ichi Miyatake and Masao Tsuji

I n recent years, photodynamic diagnosis and therapy for high-grade malignant gliomas have received increasing attention. 5 , 6 , 11–15 Fluorescent dyes that include fluorescein sodium, 6 , 13 5-ALA, 11 , 15 and porfimer sodium 12 are used for photodynamic diagnosis and therapy. A surgical microscope with a fluorescence system can facilitate the resection of malignant gliomas because fluorescent images enable the surgeon to discriminate between the tumor tissue and the surrounding brain tissues. 6 , 15 In clinical fields other than neurosurgery

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Yoshinaga Kajimoto, Toshihiko Kuroiwa, Shin-Ichi Miyatake, Tsugumichi Ichioka, Minoru Miyashita, Hidekazu Tanaka and Motomu Tsuji

R ecent advances in fluorescence diagnostic technology make it easier to reliably achieve complete excision of malignant gliomas. 22 , 24 Gross-total resection has been shown to prolong the survival time of glioblastoma patients. 12 , 20 , 22 Historically, two fluorescent agents, fluorescein sodium 11 , 20 and 5-ALA, 13 , 22 , 23 have been used in glioma surgery. Because of its high tumor specificity and safety, 5-ALA is particularly promising. It actively accumulates in the neoplasm and is converted to PPIX, which is fluorescent. 16 , 24 This

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Kyouichi Suzuki, Namio Kodama, Tatsuya Sasaki, Masato Matsumoto, Tsuyoshi Ichikawa, Ryoji Munakata, Hiroyuki Muramatsu and Hiromichi Kasuya

T o confirm the patency of the parent artery, perforating artery, and other arteries that branch near aneurysms, various methods of intraoperative monitoring such as Doppler ultrasonography, 16 conventional cerebral angiography, 2 , 20 and electrophysiological monitoring of evoked potentials 8 , 15 , 18 , 19 have been used during aneurysm surgery. In addition to these methods, fluorescent angiography using fluorescein sodium or indocyanine green has also been reported. 13 , 21 , 22 These methods of external illumination did not allow sufficient light

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Andreas Raabe and Robert F. Spetzler

aneurysm clip placement, the target arteries were illuminated using a beam from a blue light-emitting diode atop a 7-mm diameter pencil-type probe. In all patients, after intravenous administration of 5 ml of 10% fluorescein sodium, fluorescence in the vessels was clearly observed through a microscope and recorded on videotape. Results The excellent image quality and spatial resolution of the fluorescein angiography procedure facilitated intraoperative real-time assessment of the patency of the perforating arteries and branches near the aneurysm, including: 12

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Geoffrey P. Colby, Alexander L. Coon, Daniel M. Sciubba, Ali Bydon, Philippe Gailloud and Rafael J. Tamargo

. Fluorescent angiography performed using fluorescein sodium was first introduced into neurosurgery by Feindel et al. 3 to examine the cerebral microcirculation. Although fluorescein has been used by certain groups, 1 , 13 , 17 ICG has emerged as the preferred dye for microsurgical application because of improved vessel contrast for both primary and repeat dye administration. 11 The ICG angiography method is a simple, safe, and accurate way of assessing real-time vascular anatomy and flow dynamics at critical steps during an operation, particularly at clip application. 10

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David W. Roberts, Pablo A. Valdés, Brent T. Harris, Kathryn M. Fontaine, Alexander Hartov, Xiaoyao Fan, Songbai Ji, S. Scott Lollis, Brian W. Pogue, Frederic Leblond, Tor D. Tosteson, Brian C. Wilson and Keith D. Paulsen

I nterest in the clinical use of fluorescence guidance for resection of malignant gliomas, meningiomas, and metastatic brain tumors has grown over the last decade. 5 , 8 , 10 , 12–16 , 21 , 23 , 24 , 26–33 , 35 Trials of fluorescein sodium to produce intraoperative fluorescence for resection of brain tumors were first reported in 1948 by Moore et al., 20 and later, in 1982, by Murray. 22 More recently, fluorescence guidance has taken advantage of intrinsic metabolic and structural changes that occur within tumors by exploiting the heme biosynthetic