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Metastasis Removal in OR 12

The navigation here is an intimate dance as the tissue is pushed on all sides.

Published onOct 25, 2022
Metastasis Removal in OR 12

Audioguide English

Neurosurgeon Ran Xu lets out a sigh of approval as she watches on the microscope screen how the chief is handling a huge metastatic tumor. Turning it in all directions, clipping the vessels as they appear, and making sure that no major disruption will be caused when the big piece of flesh will be taken out, the professor is about to scoop that thing out of the patient’s brain. The navigation here is an intimate dance as the tissue is pushed on all sides. The sense of where to go next is less of a step-by-step planned mission following a strict itinerary and more of a very speedy wrestling with a thing that needs to be expunged but isn’t willing to go. As if it had to be pulled out quickly before it was fully awake.  

Once the whitish clump has been removed, the chief tracks down its remains using fluorescein: for a brief daunting moment, the OR gets dark and the screens relay the image of the tumorous tissues glowing up in a sci-fi greenish fluorescent yellow.  The surgeon is guided by light now.

After a few more scoops, the lamplight comes back, and a new long phase starts for the team: reconstructing the cavity where the tumor had invaded the tissue. 

Next: Calls And Organisation Work In Between

Anna L. Roethe:
  • Moore, G. E., and W. T. Peyton. “The Clinical Use of Fluorescein in Neurosurgery; the Localization of Brain Tumors.” Journal of Neurosurgery 5, no. 4 (July 1948): 392-98. 

  • Acerbi, Francesco, Morgan Broggi, Karl-Michael Schebesch, Julius Höhne, Claudio Cavallo, Camilla De Laurentis, Marica Eoli, et al. “Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO).” Clinical Cancer Research: An Official Journal of the American Association for Cancer Research 24, no. 1 (January 1, 2018): 52–61.

  • Hansen, Rasmus W., Christian B. Pedersen, Bo Halle, Anders R. Korshoej, Mette K. Schulz, Bjarne W. Kristensen, and Frantz R. Poulsen. “Comparison of 5-Aminolevulinic Acid and Sodium Fluorescein for Intraoperative Tumor Visualization in Patients with High-Grade Gliomas: A Single-Center Retrospective Study.” Journal of Neurosurgery, October 2019, 1–8.

Anna L. Roethe:

The application of this dye to brain tumor surgery has been described first by Moore & Peyton 1948; until today, it remains subject of several studies investigating its added benefit for safe and complete resection.