PMC9808466_01
Preoperative, intraoperative and postoperative images of the patient. A-C. Preoperative axial T1 after contrast administration (A), coronal FLAIR (B) and sagittal T1 after contrast administration (C) MRI images of a left posterior frontal/para-trigonal HGG. As it can be seen, the ring-enhancing lesion is surrounded by diffuse brain edema. D. Intraoperative view during HGG removal with (very high dosage) SF-guided technique. The high basal fluorescence of the lesion and surrounding brain parenchyma (to note the high fluorescence intensity of dura, blue arrow) partially affected the clear discrimination between pathologic and healthy brain tissue. This aspect is clearly visible if the image in D is compared to a (normal dose) SF-guided technique removal of another HGG in a different patient (E), where tumor tissue is clearly different in fluorescence intensity if compared to normal brain parenchyma and dura mater fluorescence appears less intense (blue arrow in E). F. Postoperative CT scan disclosing the removal of the brain lesion, in absence of hemorrhagic complications. Unfortunately, we did not produce MRI images in the early postoperative period due to instrument breakdown. A postoperative MRI was taken in the rehabilitation clinic but, unfortunately, we were not able to obtain the images of the study. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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SF technique with the aid of intraoperative motor evoked potentials monitoring, Magnetic Resonance (MR) and Computed Tomography (CT)-based neuro-navigation (BrainLab AG  Munich, Germany). Soon after patient intubation, a SF dose ten-times-bigger than recommended was erroneously injected to the patient due to an anesthesiologist mistake during the preparation of the drug (almost 30 mg/kg), resulting anyway in a GTR of the tumor (Fig. 1).