Radio-guided brain tumorectomy using a gamma detecting probe and a mobile solid-state gamma camera.
BACKGROUND
We herein report a technique to distinguish brain tumors from normal brain tissue during surgery using a gamma probe and a solid-state mobile gamma camera after (99m)Tc-hexakis-2-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) is administered to patients immediately before operation.


METHODS
We examined 13 patients with brain tumors. Before the operation, (99m)Tc-MIBI single photon emission computed tomography (SPECT) was performed to assess accumulation in the tumors. On the day of the operation, (99m)Tc-MIBI was administered intravenously and craniotomy for tumor resection was performed. During the operation, the tumor was localized with a gamma probe and preremoval scintigraphy images were taken with a mobile gamma camera. After tumor resection was completed, residual tumors were confirmed using it again. We compared accumulation found in the preoperative SPECT images and intraoperative scintigraphy images, performed a histologic examination of adjacent tissues, and measured the dose the personnel was exposed to per operation.


RESULTS
In all patients, tumors were confirmed by a gamma probe and scintigraphy during the operation. Intraoperative accumulation in tumors was significantly related to accumulation found in the preoperative (99m)Tc-MIBI SPECT images. In 9 out of 13 patients, accumulation disappeared in the postremoval scintigraphy images, and no tumor tissue was found by histologic examination. Residual tumor tissue was found in 4 patients. Average exposure of the personnel per operation was 22.9 +/- 4.0 microSv.


CONCLUSIONS
Resection of brain tumors with a gamma probe and a mobile gamma camera was very useful since the area to be removed was easily identified and residual tumors could be detected.
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
Toyoyuki
T
Kojima
Shin-Ichiro
S
Kumita
Fumio
F
Yamaguchi
Sunao
S
Mizumura
Takayuki
T
Kitamura
Tatsuo
T
Kumazaki
Akira
A
Teramoto
D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D015902:Gamma Cameras; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*; D016896:Treatment Outcome
D017256:Technetium Tc 99m Sestamibi