Removal of a malignant cystic brain tumor utilizing pyoktanin blue and fibrin glue: Technical note

Abstract

Background: The leakage of cystic fluid during metastatic cystic brain tumor resection may cause tumor dissemination. When the cyst wall is thin, excision without removing the wall is often difficult.

Methods: We were able to perform an en bloc resection of a cystic malignant brain tumor after aspirating the cystic fluid, injecting pyoktanin blue into the cyst to stain the cyst walls, and solidifying the empty cyst cavity by filling it with fibrin glue.

Results: Pyoktanin blue readily stained the thin cystic walls and enabled visualization of mural damage. Solidification of the tumor made it easier to grasp and facilitated the dissection of tumor margins.

Conclusions: This method has the potential to become a useful technique for the resection of malignant cystic brain tumors.

Keywords: Cystic malignant brain tumor; fibrin glue; operative technique; pyoktanin blue.

Figure 1

Gadolinium-enhanced magnetic resonance images (a, axial b, coronal) reveal a ring-shaped enhancement in the left parietal lobe and peritumoral cerebral edema associated with a cystic lesion

Figure 2

Intraoperative echo examination. (a) Pre-punctured cystic tumor is stored its fluid contents. (b) Post-punctured cystic tumor is deflated by aspirating its fluid contents

Figure 3

Resected tumor: thin cyst wall is well stained of pyoctanin blue (arrow) and fibrin glue is in the tumoral cavity (arrow head)

Figure 4

Permanent histopathology is glioblastoma multiforme (GBM). (a) H and E staining pathology show the central necrosis, pseudopalisading, and mitosis. (b) Atypical cell is presented in the cystic liquid contents by Papanicolaou staining pathology (Class IV)

Figure 5

Gadolinium-enhanced magnetic resonance images (a, axial b, coronal) show no contrast tumor as of one day postoperatively