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. 2014 Jun 25:5:100.
doi: 10.4103/2152-7806.135304. eCollection 2014.

Novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue for complete resection

Takeshi Okuda  1 , Mitsugu Fujita  2 , Hiromasa Yoshioka  1 , Takayuki Tasaki  1 , Amami Kato  1
Affiliations

Novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue for complete resection

Takeshi Okuda et al. Surg Neurol Int. .

Abstract

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.

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Figures

Figure 1
Figure 1
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
Figure 2
Figure 2
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
Figure 3
Figure 3
Intraoperative ultrasound photographs. (a) Before drainage of the cyst contents. (b) After the drainage of cyst contents followed by injection of autologous fibrin glue. The tumor size reduces to less than half of the original size. The cyst wall is thickened
See this image and copyright information in PMC

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