Fluorescein sodium-guided surgery in cerebral lymphoma

Schebesch, Karl-Michael; Hoehne, Julius; Hohenberger, Christoph; Acerbi, Francesco; Broggi, Morgan; Proescholdt, Martin; Wendl, Christina; Riemenschneider, Markus J.; Brawanski, Alexander

doi:10.1016/j.clineuro.2015.09.015

Cited by 51 publications

(29 citation statements)

References 17 publications

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“…Bright fluorescent staining was found in 90% of the patients, and the GTR rate was 83.3% (45). In an editorial to this report, Gempt and Meyer supported our impression that FL may be beneficial in CM surgery.…”

Section: Low-dose Fl and Dedicated Filterssupporting

confidence: 66%

Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future projects

Schebesch

Brawanski²,

Hohenberger³

et al. 2016

Turkish Neurosurgery

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Section: Low-dose Fl and Dedicated Filterssupporting

confidence: 66%

Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future projects

Schebesch

Brawanski²,

Hohenberger³

et al. 2016

Turkish Neurosurgery

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“…However, complication rates associated with a variety of surgical procedures have decreased over time [16], including neurosurgical procedures [17, 18], and complications rates from general anesthesia have also decreased [19]. Moreover, technological innovations have proliferated since the early literature on PCNSL resective surgery, including increased use of MRI [20], frameless stereotaxy [21], tumor visualization technologies [22], and improved perioperative care. These technologies and practices have contributed to the safety of modern intracranial surgery [19].…”

Section: Introductionmentioning

confidence: 99%

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

et al. 2017

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Object Surgical resection is not the standard of care for primary central nervous system lymphoma (PCNSL), as historical studies have demonstrated unfavorable complication rates and limited benefits. Some recent studies suggest that resection may provide a therapeutic benefit, yet the safety of these procedures has not been systematically investigated in the setting of modern neurosurgery. We examined the safety of surgical resection for PCNSL. Methods We retrospectively analyzed all patients with PCNSL treated at Columbia University Medical Center between 2000 and 2015 to assess complications rates following biopsy or resection using the Glioma Outcomes Project system. We identified predictors of complications and selection for resection. Well-validated scales were used to quantify patients’ baseline clinical characteristics, including functional status, comorbid disease burden, and cardiac risk. Results The overall complication rate was 17.2% after resection, and 28.2% after biopsy. Cardiac risk (p = 0.047, OR 1.72 [1.01, 2.95]), and comorbid diagnoses (p = 0.004, OR 3.05 [1.42, 6.57]) predicted complications on multivariable regression. Patients who underwent resection had better KPS scores (median 70 v. 80, p = 0.0068, Δ 10 [0.0, 10.00]), and were less likely to have multiple (46.5% v. 27.6%, p = 0.030, OR 1.42 [1.05, 1.92]) or deep lesions (70.4% v. 39.7%, p = 0.001, OR 1.83 [1.26, 2.65]). Age (p = 0.048, OR 0.75 per 10-year increase [0.56, 1.00]) and deep lesions (p = 0.003, OR 0.29 [0.13, 0.65]) influenced selection for resection on multivariable regression. Conclusions Surgical resection of PCNSL is safe for select patients, with complication rates comparable to rates for other intracranial neoplasms. Whether there is a clinical benefit to resection cannot be concluded.

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“…11 Despite the application of intraoperative adjuvant techniques, such as neuronavigation, neurophysiological monitoring, and the popularization of intraoperative ultrasound, the surgical procedure is still associated with high morbidity and mortality. The application of fluorescenceguided surgery has shown significant benefit in surgery for high-grade gliomas, 4,5 cerebral metastases, 6,7 primary central nervous system lymphomas, 12 and even benign lesions, such as meningiomas and abscess. 13,14 The goal of surgery is to reduce the tumor as much as possible and to seek a balance point between the GTR and postoperative neurological function.…”

Section: Discussionmentioning

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 surgery in cerebral lymphoma

Cited by 51 publications

References 17 publications

Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future projects

Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future projects

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

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

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