Fluorescein-guided resection of cerebral metastases is associated with greater tumor resection

Kofoed, Mikkel Seremet; Pedersen, Christian Bonde; Schulz, Mette Katrine; Kristensen, Bjarne Winther; Hansen, René Skov; Marković, Ljubo; Halle, Bo; Poulsen, Frantz Rom

doi:10.1007/s00701-021-04796-1

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…Complete surgical resection is advocated; in fact, some Authors demonstrated the correlation between the extent of resection and recurrence rate, progression-free survival, overall survival and quality of life [7,24,26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Six papers were then excluded with the following reasons: case reports and opinion articles. Finally, 10 studies (290 patients) matched the inclusion criteria, and were included in the present review [15][16][17][18][19][20][21][22][23][24].…”

Section: Systematic Review Of the Literaturementioning

confidence: 99%

“…The use of this dye is known in neurosurgery since 1947 when G.E.Moore et al reported their rst experience in a series of 46 patients [13]. Some authors reported their impressions in the application of uorescein sodium for the resection of brain metastasis with promising results [14][15][16][17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Sodium-fluorescein Guided Resection in Brain Metastases Surgery: Our Results in a Series of 59 Patients

Fuschillo¹,

Mongardi²,

D'Andrea³

et al. 2021

Preprint

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Metastasis are the most common tumors in the brain, nowadays surgical resection still remains the treatment of choice in patients eligible for surgery.Several tools and techniques have been proposed to improve the resection rate but few datas are available on the application of fluorescence guided surgery for brain metastases resectionPurpose: the aim of the study was to assess the safety and efficacy of the fluorescence-guided surgery through the application of sodium fluorescein (SF) detected by Yellow 560nm filter for brain metastases surgery Methods: 75 Patients operated from January 2015 to January 2020 were retrospectively analyzed and 59 patients recruited. The patients were divided into group A of 30 (fluorescein-guided surgery group of 30 patients) and group B (control- standard white light microsurgery of 29 patients). In group A a 5 mg/kg bodyweight of FL was intravenously injected at scalp incision. A yellow 560 filter was employed for microsurgical tumor resection. Preoperative and postoperative metastases volume analysis was performed to evaluate the extent of resection and the residual tumor rateResults: Median preoperative Volume (cm3) was 11.85 (range 2.5-90) in group A and 10 (range 1-48) in group B. Median residual tumor volume (RTV) after surgery was 0 (0-1.0) in group A and 0.4 (0-2.0) in group B whereas median EOR was 100% (0,8-1) in the group A and 98,2% (0,43-1) in group B. Conclusion: SF-guided surgery using YELLOW 560 nm microscope filter should be considered a safe and useful procedure and effective to improve the extent of resection even in metastatic tumor surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Systematic Review Of the Literaturementioning

confidence: 99%

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Sodium-fluorescein Guided Resection in Brain Metastases Surgery: Our Results in a Series of 59 Patients

Fuschillo¹,

Mongardi²,

D'Andrea³

et al. 2021

Preprint

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“… 142 , 143 , 146 Retrospective studies comparing fluorescein-guided surgery and white light-guided surgery suggest that fluorescein may be associated with better GTR rates, postoperative KPS, and survival. 144 , 147 In conclusion, fluorescein can safely and consistently localize BMs, though its clinical value is yet to be definitively determined.…”

Section: Intraoperative Augmentationmentioning

confidence: 95%

Surgical advances in the management of brain metastases

Choi

Aghi

et al. 2021

Neuro-Oncology Advances

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As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.

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“…This will help to understand the full clinical impact of extent of resection in patients undergoing surgery for single brain metastasis. The use of intraoperative fluorescein [9,24] may improve the identification of unintended residual tumor, making gross total resection more achievable. Combining this with improved intraoperative neuro-navigation, imaging and monitoring might allow supra-marginal resection to reduce neurological death and increase overall survival, without augmenting the risk of postoperative neurological deficits in this patient group.…”

Section: Extent Of Resectionmentioning

confidence: 99%

Surgery for brain metastases—impact of the extent of resection

et al. 2022

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Background Surgical resection of brain metastases improves symptoms and survival in selected patients. The benefit of gross total resection is disputed, as most patients are believed to succumb from their non-CNS tumor burden. We investigated the association between overall survival and residual tumor after surgery for single brain metastases. Methods We reviewed adults who underwent surgery for a single brain metastasis at a regional referral center (2011–2018). Gross total resection was defined as no visible residual tumor on cerebral MRI 12–48 h postoperatively. Results We included 373 patients. The most common primary tumors were lung cancer (36%) and melanoma (24%). We identified gross total resection in 238 patients (64%). Median overall survival was 11.0 months, 8.0 (6.2–9.8) months for patients with subtotal resection and 13.0 (9.7–16.3) months for patients with gross total resection. In a multivariate regression analysis including preoperative prognostic factors, gross total resection was associated with longer overall survival (HR: 0.66, p = 0.003). Postoperative radiotherapy administered within 6 weeks did not significantly alter the hazard ratio estimates for grade of resection. Conclusions Our study suggests improved survival with gross total resection compared to subtotal resection. The importance of extent of resection in surgery for brain metastases should not be discarded.

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Fluorescein-guided resection of cerebral metastases is associated with greater tumor resection

Cited by 17 publications

References 24 publications

Sodium-fluorescein Guided Resection in Brain Metastases Surgery: Our Results in a Series of 59 Patients

Sodium-fluorescein Guided Resection in Brain Metastases Surgery: Our Results in a Series of 59 Patients

Surgical advances in the management of brain metastases

Surgery for brain metastases—impact of the extent of resection

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