Intraoperative Fluorescein Sodium in Pediatric Neurosurgery: A Preliminary Case Series from a Singapore Children’s Hospital

Abstract

(1) Background: Fluorescein sodium (Na-Fl) has been described as a safe and useful neurosurgical adjunct in adult neurooncology. However, its use has yet to be fully established in children. We designed a study to investigate the use of intraoperative Na-Fl in pediatric brain tumor surgery. (2) Methods: This is a single-institution study for pediatric brain tumor patients managed by the Neurosurgical Service, KK Women’s and Children’s Hospital. Inclusion criteria consists of patients undergoing surgery for suspected brain tumors from 3 to 19 years old. A predefined intravenous dose of 2 mg/kg of 10% Na-Fl is administered per patient. Following craniotomy, surgery is performed under alternating white light and YELLOW-560 nm filter illumination. (3) Results: A total of 21 patients with suspected brain tumours were included. Median age was 12.1 years old. For three patients (14.3%), there was no significant Na-Fl fluorescence detected and their final histologies reported a cavernoma and two radiation-induced high grade gliomas. The remaining patients (85.7%) had adequate intraoperative fluorescence for their lesions. No adverse side effects were encountered with the use of Na-Fl. (4) Conclusions: Preliminary findings demonstrate the safe and efficacious use of intraoperative Na-Fl for brain tumors as a neurosurgical adjunct in our pediatric patients.

On the Solvatochromism of Fluorescein Sodium

“…As an alternative to using high doses, Kuroiwa et al developed a modified operative microscope having the same ocular lens for operation and fluorescence visualization [15]. As in the case of fluorescence angiography, fluorescence image-guided surgery and fluorescence-guided resection have become routine neurosurgical practice during tumor surgery [16][17][18], also in the case of pediatric patients [19]. Recently, it was proven that fluorescein sodium is a helpful microsurgical tool also for the biopsy of intramedullary spinal cord lesions [20], as well as in the surgery of spinal arteriovenous malformation [21].…”