Fluorescein-guided resection of plexiform neurofibromas: how I do it
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Plexiform neurofibromas (PN) can determine pain, nerve function impairment, and, when extremely large, also deformity. Surgical is often partial, with possible recurrence, and the risk of malignant transformation.
We describe the surgical strategy in a case of huge multiple plexiform neurofibromas of the left arm. We attempted to achieve a safe resection under the intraoperative guidance of fluorescein, with a dedicated microscope filter (YELLOW560). This technique can be also applied to other locations.
Fluorescein-guided surgery, coupled with intraoperative neurophysiological monitoring, increases the safe resection rate, considering the risks of neurological deficits and the possible malignant transformation.
KeywordsFluorescein Neurofibromatosis Peripheral nervous system tumor Plexiform neurofibroma YELLOW560 filter
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The patient and next of kin have consented to the submission of this “How I Do It” to the journal.
All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The video shows the different phases of the surgical procedures, from positioning and skin incision to the tumor removal. Preoperative MRI and intraoperative Doppler-US examination are depicted too. (MP4 253,977 kb)
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