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

Abstract

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.