- Department of Neurosurgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
- Department of Microbiology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
Department of Neurosurgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
DOI:10.4103/2152-7806.135304Copyright: © 2014 Okuda T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Okuda T, Fujita M, Yoshioka H, Tasaki T, Kato A. Novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue for complete resection. Surg Neurol Int 25-Jun-2014;5:100
How to cite this URL: Okuda T, Fujita M, Yoshioka H, Tasaki T, Kato A. Novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue for complete resection. Surg Neurol Int 25-Jun-2014;5:100. Available from: http://sni.wpengine.com/surgicalint_articles/novel-surgical-technique-to-solidify-cyst-type-metastatic-brain-tumors-using-autologous-fibrin-glue-for-complete-resection/
Background:An outstanding issue regarding the surgical treatment of cyst-type metastatic brain tumors is the incomplete resection of cyst walls. Herein we propose a novel surgical technique that can overcome this issue. During a surgical procedure for cystic tumors, autologous fibrin glue is to be injected into the tumor cysts, which solidifies the cyst lumens and cyst walls en bloc with reducing the tumor size. As a result, tumor masses and cyst walls can be removed completely in an en bloc fashion in all cases.
Methods:The illustrative case presented in this report is a patient with metastatic brain tumors in the frontal lobe. When we reached the tumor wall surgically, we first suctioned out the cyst content and subsequently injected autologous fibrin glue into the cyst lumen. The autologous fibrin glue solidified the tumor en bloc, and we resected the tumor mass and the cyst walls in an en bloc fashion.
Results:We have applied this technique to four cases with cyst-type metastatic brain tumors. This approach made it possible to perform ideal en bloc resection in all cases. There were no adverse events due to the autologous fibrin glue.
Conclusion:We developed a novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue, which allows en bloc resection of tumor masses and cyst walls quite safely using inexpensive materials. Given these advantages, it appears a promising surgical strategy for cyst-type metastatic brain tumors.
Keywords: Autologous fibrin glue, brain metastasis, cystic brain tumor
Among various therapeutic approaches for metastatic brain tumors, surgical resection is the most powerful because it allows a substantial reduction in tumor volume. In particular, en bloc resection of tumors is considered ideal (including those with a circumferential margin of about 5 mm).[
Herein we show an illustrative case of metastatic brain tumor in bilateral frontal lobes [
MR images before and after surgery. (a) Preoperative images. The tumors are located in the bilateral frontal lobes; the present method is planned for the right frontal lesion. (b) Postoperative images 1 day after surgery. Total resection of the tumor is achieved with no tumor remnants. Both are coronal contrast-enhanced T1-weighted images
Intraoperative photographs. (a) Cyst contents are drained and the lumen is observed. (b) Autologous cryoprecipitate and thrombin solution are injected simultaneously. (c) Tumor cyst is solidified. The autologous fibrin glue is filled to level of the injection site. (d) En bloc resection is performed including the cyst walls. (e) Resected tumor. Arrow: the injection site. (f) Separation of the solidified autologous fibrin glue from the cystic tumor
We have applied this technique to four cases with cyst-type metastatic brain tumors. This approach made it possible to perform ideal en bloc resection in all cases. There were no adverse events, local recurrence, and/or dissemination observed during 3 months follow-up periods.
Autologous fibrin glue was first reported in 1983 and is currently used in various surgical procedures.[
We used the autologous fibrin glue to solidify tumor cyst lumens and cyst wall en bloc. This method allows complete resection of tumor masses and cyst walls in most cases. Previously, cotton sheets, hydrofiber dressing, or some other solid-state materials have been used to solidify the cystic tumors.[
We have not achieved long-term follow-up for the patients thus far. However, mid-term follow-up (3 months at shortest) indicates no local recurrence or dissemination. However, it still remains to be elucidated whether this technique contributes to reduce local failure and/or dissemination during long-term follow-up periods after surgery.
A disadvantage of the present method is that autologous blood draw is necessary prior to surgery. Since advanced cancer patients often exhibit chronic anemia, even a small volume of blood draw (200 ml) could be a heavy burden. Another possible issue is that viral infection or allergic reactions may occur because thrombin is derived from pooled human serum. To overcome this issue, complete thrombin isolation and purification system is currently under development.[
We developed a novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue. This procedure allowed en bloc resection of tumor masses as well as cyst walls in all cases quite safely using inexpensive materials. Given these advantages, it appears a promising surgical strategy for cyst-type metastatic brain tumors.
Author contributions to the study and manuscript preparation include the following: Conception and design: Okuda. Acquisition of data: All authors. Drafting the article: Okuda, Fujita. Study supervision: Kato.
Dr. Kato has received support from GlaxoSmithkline K.K. and Otsuka Pharmaceutial Co., Ltd for nonstudy-related clinical or research effort. Other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this manuscript.
The authors thank Ms. Heather A. Garing at Children's Hospital of UPMC for her writing/proofing assistance.
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