Fluorescein sodium-guided resection of cerebral metastases—experience with the first 30 patients

Schebesch, Karl‐Michael; Hoehne, Julius; Hohenberger, Christoph; Proescholdt, Martin; Riemenschneider, Markus J.; Wendl, Christina; Brawanski, Alexander

doi:10.1007/s00701-015-2395-7

Cited by 72 publications

(46 citation statements)

References 29 publications

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“…[7] The cost of one application of 5-ALA is approximately 200 times higher than one administration of FS (approximately 980€ and 5€, respectively). [30] The use of specific filters on surgical microscope allows an optimal delineation of tumoral tissue, assuring the visualization of the fluorescent areas, and distinguishing them from the peritumoral brain parenchyma and from vessels, which appear of “more natural” colors. [4] It should be emphasized that fluorescence technology shows BBB breakdowns, corresponding to the areas marked by the contrast agent in MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Widely used in ophthalmic surgery, fluorescein is injected intravenously just before glioma resection, it is virtually free of side effects and has low costs, approximately 5 euros each vial (1 g of substance). [330] It is usually visible to the naked eye at high dosage (20 mg/kg body weight) and at lower doses, it is observable under the YELLOW 560 nm surgical microscope filter, allowing a better tissue discrimination with more natural colors [Table 1]. [1032] In this study, we report our preliminary data retrospectively collected on 47 patients operated for HGGs.…”

Section: Introductionmentioning

confidence: 99%

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Fluorescein for resection of high-grade gliomas: A safety study control in a single center and review of the literature

Francaviglia¹,

Iacopino²,

Costantino³

et al. 2017

Surg Neurol Int

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Background:The importance of a complete resection of high-grade gliomas (HGGs) has been highlighted in scientific literature, in order to limit tumor recurrence and above all to improve disease-free survival rates. Several fluorescent biomarkers have been tested to improve intraoperative identification of residual tumor; 5-aminolevulinic acid (5-ALA) and fluorescein sodium (FS) are now starting to play a central role in glioma surgery. We performed a retrospective analysis on 47 patients operated for HGGs. Here we report our preliminary data.Methods:Data of 47 consecutive patients with HGG have been collected in our study (25 males, 22 females; mean age: 60.3 years, range: 27–86 years). Fluorescein (5 mg/kg of body weight) was injected intravenously right after the induction of general anesthesia. A YELLOW 560 filter was used on an OPMI Pentero 900 microscope (Carl Zeiss Meditec, Oberkochen, Germany) to complete a microsurgical tumor removal. Glioma resection and quality of life were evaluated preoperative and postoperatively.Results:Gross total resection (GTR) was achieved in 53.2% (n = 25) of patients. A subtotal resection (STR) (>95%) was achieved in 29.8% (n = 14), while a partial resection (PR) (<95%) was obtained in 17% (n = 8) of patients. Overall, in 83% (n = 39) of patients who underwent fluorescence-guided surgery the resection rate achieved was >95%. No adverse effects correlated to fluorescein have been recorded.Conclusion:Fluorescein seems to be safe and effective in the resection of HGGs, allowing a high rate of gross total removal of contrast enhanced areas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fluorescein for resection of high-grade gliomas: A safety study control in a single center and review of the literature

Francaviglia¹,

Iacopino²,

Costantino³

et al. 2017

Surg Neurol Int

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“…Y560 filter) for resecting malignant brain tumors has been documented in several case series [1, 10, 11] in our institution. The use of FL in combination with the 560 nm filter and the PENTERO microscope for parotidectomy was a logical conclusion.…”

Section: Discussionmentioning

confidence: 99%

Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance

Haubner¹,

Gassner²,

Brawanski

et al. 2017

BMC Ear Nose Throat Disord

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BackgroundComplete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor tissue and allows to identify residual tumor tissue could be Fluorescein Sodium.MethodsRetrospective chart analysis on 7 patients with benign parotid gland lesions that were operated using Fluorescein Sodium intravenously and the application of the YELLOW 560 nm filter of the operating microscope. Safety and feasibility were evaluated.ResultsAll tumors showed fluorescence and the rating ´contrast-enhancing´ was assigned in all cases. In 2 patients, satellite nodules were identified and resected meaning that the fluorescence staining of the tumor margins was significantly better than under white light.ConclusionThe use of Fluorescein Sodium in parotidectomy is promising. In two cases residual tumor was detected that would have been left behind under white light. Further research in parotid gland surgery and other head and neck tumor procedures is warranted.

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“…Fluorescence-guided surgery utilizing sodium fluorescein has been proven to be a safe and effective adjunct for the removal of malignant brain tumors. [4][5][6][7] The primary advantage of fluorescence-guided surgery is to facilitate the resection by demarcating the tumor margin from the normal brain tissue in real time, with relatively easy preparation and low cost. 8,9 In this retrospective study, we report the first experiences using sodium fluorescein in pediatric patients with BsG.…”

Section: Introductionmentioning

confidence: 99%

Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

et al. 2018

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Brainstem gliomas (BsG) account for 10 to 15% of pediatric brain tumors. Surgery is the preferred treatment for focal and exophytic lesions. Sodium fluorescein has been proven safe and effective in resection of malignant brain tumors. The objective was to o analyze the safety and effectiveness of this approach, to evaluate intraoperative fluorescein imaging, and to measure the safety of chosen dose for pediatric patients. Twelve cases were enrolled between March 2014 and September 2016 in Beijing Tiantan Hospital. All of the patients received 2.5 mg/kg of sodium fluorescein before opening the dura; the intraoperative fluorescence enhancement was observed, and the degree of satisfaction and consistency with the neuronavigation were evaluated. With a mean age of 7.5 years, there were eight cases located within the pontine, three in the medullary oblongata, and one in the tectal plate. Histological results were astrocytoma, glioblastoma, oligodendroglioma, and pilocytic astrocytoma. Under the fluorescein module of the microscope, the tumors were recognizable enough to help surgeons to discriminate the lesion from non-fluorescent tissue, with a consistency of 83% with the neuronavigation. Total removal was accomplished in nine cases, while the mean percentage of resection of the other cases was 93.7%. The Karnofsky performance score (KPS) showed no significant differences between pre-operation and discharge, but there was a difference between pre-operation and 6-month follow-up. The fluorescein-guided surgery is useful for demarcating the tumor margin and works well with other navigation and monitoring devices. A safe dose of sodium fluorescein (2.5 mg/kg) was proven effective for children.

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Fluorescein sodium-guided resection of cerebral metastases—experience with the first 30 patients

Abstract: FL and the YELLOW 560 nm filter are safe and practical tools for the resection of CM, but further prospective research is needed to confirm that this advanced technique will improve the quality of CM resection.

Cited by 72 publications

References 29 publications

Fluorescein for resection of high-grade gliomas: A safety study control in a single center and review of the literature

Fluorescein for resection of high-grade gliomas: A safety study control in a single center and review of the literature

Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance

Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

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