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Sodium fluorescein–guided brain tumor surgery under the YELLOW-560-nm surgical microscope filter in pediatric age group: feasibility and preliminary results

  • Burcu Göker
  • Talat Kırış
Original Article

Abstract

Objective

To evaluate the feasibility and safety of sodium fluorescein (Na-Fl)–guided surgery with the use of the PENTERO 900 surgical microscope (Carl Zeiss, Meditec, Oberkochen, Germany) equipped with the YELLOW-560-nm filter and low-dose Na-Fl (2 mg/kg) in pediatric brain tumor surgery.

Methods

The study included 23 pediatric patients with various intracranial pathologies, who underwent Na-Fl-guided surgery between April 2015 and February 2018. Clinical features, surgical observations, extent of resection, and tumor histopathology were retrospectively analyzed. The use of YELLOW-560-nm filter was found “helpful” if the discrimination of the pinkish brain tissue and bright yellow stained tumor tissue was clear. Otherwise, it was described as “not helpful.”

Results

There were 11 female and 12 male patients with a mean age of 9.4 years. There were 7 brain stem/tectal plate gliomas, 6 supratentorial tumors, 4 intraventricular tumors, 2 pineal tumors, 2 infratentorial tumors, 1 clivus tumor, and 1 tumor with supra- and infratentorial extensions in the current series. Na-Fl was found helpful by means of the tumor demarcation in 20 instances (87%). In 11 of these 20 operations (55%), a total resection was achieved regardless of the tumor pathology. A subtotal resection was achieved in the remaining 9 patients (45%). No adverse events or side effects were encountered with regard to Na-Fl use.

Conclusion

Na-Fl guidance with the use of the YELLOW-560 filter is safe and effective during brain tumor surgery in pediatric age group.

Keywords

Sodium fluorescein Surgical microscope YELLOW 560 Pediatric Brain tumor Fluorescence-guided surgery 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

References

  1. 1.
    Acerbi F, Broggi M, Eoli M, Anghileri E, Cuppini L, Pollo B, Schiariti M, Visintini S, Orsi C, Franzini A, Broggi G, Ferroli P (2013) Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases. Acta Neurochir 155:1277–1286CrossRefGoogle Scholar
  2. 2.
    Acerbi F, Broggi M, Eoli M, Anghileri E, Cavallo C, Boffano C, Cordella R, Cuppini L, Pollo B, Schiariti M, Visintini S, Orsi C, La Corte E, Broggi G, Ferroli P (2014) Is fluorescein-guided technique able to help in resection of high-grade gliomas? Neurosurg Focus 36:E5CrossRefGoogle Scholar
  3. 3.
    Acerbi F, Cavallo C, Schebesch KM, Akcakaya MO, de Laurentis C, Hamamcioglu MK, Broggi M, Brawanski A, Falco J, Cordella R, Ferroli P, Kiris T, Höhne J (2017) Fluorescein-guided resection of intramedullary spinal cord tumors: results from a preliminary, multicentric, retrospective study. World Neurosurg 108:603–609CrossRefGoogle Scholar
  4. 4.
    Akçakaya MO, Göker B, Kasımcan MÖ, Hamamcıoğlu MK, Kırış¸ T (2017) Use of sodium fluorescein in meningioma surgery performed under the YELLOW-560 nm surgical microscope filter: feasibility and preliminary results. World Neurosurg 107:966–973CrossRefGoogle Scholar
  5. 5.
    Ali SMA, Khan I, Khurram D, Kozak (2018) Ultra-widefield angiography with oral fluorescein in pediatric patients with retinal disease. JAMA Ophthalmol 136(5):593–594CrossRefGoogle Scholar
  6. 6.
    Bruna J, Brell M, Ferrer I, Gimenez-Bonafe P, Tortosa A (2007) Ki-67 proliferative index predicts clinical outcome in patients with atypical or anaplastic meningioma. Neuropathology 27:114–120CrossRefGoogle Scholar
  7. 7.
    De Bonis P, Anile C, Pompucci A, Fiorentino A, Balducci M, Chiesa S, Lauriola L, Maira G, Mangiola A (2012) The influence of surgery on recurrence pattern of glioblastoma. Clin Neurol Neurosurg 115:37–43CrossRefGoogle Scholar
  8. 8.
    Diaz RJ, Diaz RR, Hattab EM, Burrell K, Rakopoulos P, Sabha N, Hawkins C, Zadeh G, Rutka JT, Cohen-Gadol AA (2015) Study of biodistribution of fluorescein in glioma-infiltrated mouse brain and histopathological correlation of intraoperative findings in high-grade gliomas resected under fluorescein fluorescence guidance. J Neurosurg 122:1360–1369CrossRefGoogle Scholar
  9. 9.
    Fung TH, Muqit MM, Mordant DJ, Smith LM, Patel CK (2014) Noncontact high-resolution ultra-wide-field oral fluorescein angiography in premature infants with retinopathy of prematurity. JAMA Ophthalmol 132(1):108–110CrossRefGoogle Scholar
  10. 10.
    Gates M, Alsaidi M, Kalkanis S (2012) Surgical treatment of solitary brain metastases. Prog Neurol Surg 25:74–81CrossRefGoogle Scholar
  11. 11.
    Hamamcıoğlu MK, Akçakaya MO, Göker B, Kasımcan MÖ, Kırış T (2016) The use of the YELLOW 560nm surgical microscope filter for sodium fluorescein-guided resection of brain tumors: our preliminary results in a series of 28 patients. Clin Neurol Neurosurg 143:39–45CrossRefGoogle Scholar
  12. 12.
    Kamp MA, Dibue M, Niemann L, Reichelt DC, Felsberg J, Steiger HJ, Szelenyi A, Rapp M, Sabel M (2012) Proof of principle: supramarginal resection of cerebral metastases in eloquent brain areas. Acta Neurochir 154:1981–1986CrossRefGoogle Scholar
  13. 13.
    Kubben PL, ter Meulen KJ, Schijns OE, ter Laak-Poort MP, van Overbeeke JJ, van Santbrink H (2011) Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review. Lancet Oncol 12:1062–1070CrossRefGoogle Scholar
  14. 14.
    Kwan AS, Barry C, McAllister IL, Constable I (2006) Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience. Clin Exp Opthalmol 34:33–38CrossRefGoogle Scholar
  15. 15.
    Kwiterovich KA, Maguire MG, Murphy RP, Schachat AP, Bressler NM, Bressler SB, Fine SL (1991) Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology 98:1139–1142CrossRefGoogle Scholar
  16. 16.
    Lee CH, Kim DG, Kim JW, Han JH, Kim YH, Park CK, Kim CY, Paek SH, Jung HW (2013) The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study. Acta Neurochir 155:389–397CrossRefGoogle Scholar
  17. 17.
    Moore GE (1947) Fluorescein as an agent in the differentiation of normal and malignant tissues. Science 106:130–131CrossRefGoogle Scholar
  18. 18.
    Moore GE, Peyton WT, French LA, Walker WW (1948) The clinical use of fluorescein in neurosurgery: the localization of brain tumors. J Neurosurg 5:392–398CrossRefGoogle Scholar
  19. 19.
    Nimsky C, Ganslandt O, Buchfelder M, Fahlbush R (2006) Intraoperative visualization for resection of gliomas: the role of functional neuronavigation and intraoperative 1.5 T MRI. Neurol Res 28:482–487CrossRefGoogle Scholar
  20. 20.
    Novotny HR, Alvis DL (1961) A method of photographing fluorescence in circulating blood in human retina. Circulation 24:82–86CrossRefGoogle Scholar
  21. 21.
    Okuda T, Kataoka K, Yabuuchi T, Yugami H, Kato A (2010) Fluorescence guided surgery of metastatic brain tumors using fluorescein sodium. J Clin Neurocsci 117:118–121CrossRefGoogle Scholar
  22. 22.
    Orringer D, Lau D, Khatri S, Zamora-Berridi GJ, Zhang K, Wu C, Chaudhary N, Sagher O (2012) Extent of resection in patients with glioblastoma: limiting factors, perception of resectability and effect on survival. J Neurosurg 117:851–859CrossRefGoogle Scholar
  23. 23.
    Rey-Dios R, Hattab EM, Cohen-Gadol AA (2014) Use of intraoperative fluorescein sodium fluorescence to improve the accuracy of tissue diagnosis during stereotactic needle biopsy of high grade gliomas. Acta Neurochir 156:1071–1075CrossRefGoogle Scholar
  24. 24.
    Salvati M, Pichierri A, Piccirilli M, Floriana Brunetto GM, D’Elia A, Artizzu S, Santoro F, Arcella A, Giangaspero F, Frati A, Simione L, Santoro A (2012) Extent of tumor removal and molecular markers in cerebral glioblastoma: a combined prognostic factors study in a surgical series of 105 patients. J Neurosurg 117:204–211CrossRefGoogle Scholar
  25. 25.
    Schackert G, Steinmetz A, Meier U, Sobottka SB (2001) Surgical management of single and multiple brain metastases: results of a retrospective study. Onkologie 24:246–255Google Scholar
  26. 26.
    Schebesch KM, Hoehne J, Hohenberger C, Proescholdt M, Riemenschneider MJ, Wendl C, Brawanski A (2015) Fluorescein sodium-guided resection of cerebral metastases-experience with the first 30 patients. Acta Neurochir 157:899–904CrossRefGoogle Scholar
  27. 27.
    Schebesh KM, Proescholdt M, Hohne J, Hohenberger C, Hansen E, Riemenschneider MJ, Ulrich W, Doenitz C, Schlaier J, Lange M, Brawanski A (2013) Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery- a feasibility study. Acta Neurochir 155:693–699CrossRefGoogle Scholar
  28. 28.
    Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39CrossRefGoogle Scholar
  29. 29.
    Sjöback R, Nygren J, Kubista M (1995) Absorption and fluorescence properties of fluorescein. Spectrochim Acta A Mol Biomol Spectrosc 51:L7–L21CrossRefGoogle Scholar
  30. 30.
    Stark AM, Tsheslog H, Buhl R, Held-Feindt J, Mehdorn HM (2005) Surgical treatment for brain metastases: prognostic factors and survival in 177 patients. Neurosurg Rev 28:115–119CrossRefGoogle Scholar
  31. 31.
    Stummer W, Meinel T, Ewelt C, Martus P, Jakobs O, Felsberg J, Reifenberger G (2012) Prospective cohort study of radiotherapy with concomitant and adjuvant temozolamide chemotherapy for glioblastoma patients with no or minimal residual enhancing tumor. J Neuro-Oncol 108:89–97CrossRefGoogle Scholar
  32. 32.
    Unsgaard G, Ommedal S, Muller T, Gronningsaeter A, Nagelhus Herner TA (2002) Neuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resection. Neurosurgery 50:804–812CrossRefGoogle Scholar
  33. 33.
    Wirtz CR, Albert FK, Schwaderer M, Heuer C, Staubert A, Tronnier VM, Knauth M, Kunze S (2000) The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery. Neurol Res 22:354–360CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryLiv Hospital UlusIstanbulTurkey
  2. 2.Department of NeurosurgeryIstinye University Medical FacultyIstanbulTurkey

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