The role of sodium fluorescein in pediatric supratentorial intra-axial tumor resection: new insights from a monocentric series of 33 consecutive patients

Abstract

Surgical resection represents the mainstay of treatment, in pediatric central nervous system (CNS) tumors, and aggressive resection correlates with prognosis for several histotypes. Sodium uorescein (SF), a green, water-soluble dye, is used as neurosurgical uorescent tracer thanks to its property to accumulate in cerebral regions of blood-brain barrier disruption, acting as a valid tool to improve the extent of resection in tumors enhancing at preoperative MRI. Brain neoplasms represent a heterogeneous group of tumors in the pediatric age, constituting the most common solid cancers; they typically show a varying degree of contrast enhancement on MRI. In March 2016 the authors started a prospective, observational trial to evaluate intraoperative uorescence's characteristics of CNS tumors, the percentage of extent of resection thanks to uorescein aid and side effects related to uorescein administration. This report is based on a retrospective analysis of a group of 33 consecutive pediatric patients harboring a supratentorial lesion. In 17 of 33 (51.5%) procedures uorescence was reported as intense, in 14 of 33 (42.4%) moderate and in 2 of 33 (6.1%) slight. Intraoperative uorescence corresponds to preoperative MRI documented contrast enhancement. In 28 of 33 (84.8%) surgical procedures SF was considered useful, in 2 of 33 (6.1%) partial useful, and in 3 of 33 (9.1%) not essential because the tumor was already recognizable. No adverse effect to SF administration was registered. Fluorescein-guided surgery with a dedicated lter on the microscope is a safe and effective technique to improve visualization and resection of different pediatric brain tumors.