• Naokado Ikeda, Motomasa Furuse, Gen Futamura, Seigo Kimura, Naosuke Nonoguchi, Shinji Kawabata, Masahiro Kameda, Kunio Yokoyama, Toshihiro Takami, Masahiro Kawanishi, Yoshinaga Kajimoto, Toshihiko Kuroiwa, and Masahiko Wanibuchi.
• Department of Neurosurgery and Neuroendovascular surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan; Department of Neurosurgery, Ijinkai Takeda General Hospital, Fushimi, Kyoto, Japan. Electronic address: naokado.ikeda@ompu.ac.jp.
• World Neurosurg. 2022 Nov 1; 167: e1268e1274e1268-e1274.

BackgroundThe ORBEYE (ORB), an innovative 3-dimensional digital exoscope, is an equipped system for fluorescence-guided surgery with 5-aminolevulinic acid. Therefore, this study aimed to verify the characteristics of fluorescence-guided surgery with 5-aminolevulinic acid and excitation light source with ORB.MethodsThe same operative field of glioblastoma was recorded under blue light (BL) excitation using a conventional microscope (MS) and ORB. For in vitro studies, the energy of 405-nm wavelength light in white light and BL modes of each scope was examined in various focal lengths. To examine the degree of photobleaching with BL for each scope, protoporphyrin IX-soaked filter papers were continuously exposed with BL of an MS and ORB, and the video-recorded red fluorescence intensity was analyzed.ResultsThe color tone of tumor-induced red fluorescence was remarkably different under each scope. Furthermore, nonfluorescent normal structures without red fluorescence were well recognized under ORB. The energy of 405-nm wavelength light in BL was significantly higher in ORB than that in an MS, especially in the short focal length. With continuous BL excitation to filter papers, the relative red fluorescence intensity of filter papers was significantly decreased over time in ORB than in an MS. In low protoporphyrin IX concentration, the difference was more significant.ConclusionsWith ORB, the good visibility due to BL energy as compared with an MS might improve the surgical manipulation even in BL mode. However, the weak fluorescent tissue and short focal length should be carefully considered because photobleaching might be critical for FGS.Copyright © 2022 Elsevier Inc. All rights reserved.

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