A Case of Myelopathy after Intrathecal Injection of Fluorescein

Park, Kwang‐Yeol; Kim, Young Baeg

doi:10.3340/jkns.2007.42.6.492

Cited by 15 publications

(5 citation statements)

References 11 publications

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“…In every other case, no adverse events were described, in particular patients showed stability of vital parameters, no variation in renal functionality, no allergic reactions, con rming what has already been reported in the literature both in adults [16], [17], [28] and in children [22], [23], [30], [31]. Adverse events following SF utilization have occasionally been reported with high dosages [32] and through intrathecal administration [33]- [35] rather than parenteral injection.…”

Section: Discussionsupporting

confidence: 78%

Sodium fluorescein in pediatric oncological neurosurgery: a pilot study on 50 children

et al. 2022

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Background. Sodium uorescein (SF) is currently considered a valid intraoperative adjunct in the resection of high-grade brain lesions in adults. Experiences in pediatric groups and in low-grade gliomas and other low-grade lesions are still limited in literature, and subjective evaluation of uorescence is still a limitation.Material and methods. This study retrospectively reviewed all patients with brain or spine lesions operated on from September 2021 to July 2022 in the Pediatric Neurosurgery Unit of Hôpital Femme Mère Enfant, Lyon, who had received 5 mg/kg of 10%. Surgery was performed using a YELLOW560 lter at crucial times. At the end of surgery, the rst operator completed a questionnaire, including his opinion on whether SF had been useful in tumor resection, recorded as a binary variable. Post-hoc, surgical images were reviewed using ImageJ, an open-source Java image processing platform. In order to compare independent discrete variables, we applied the Student's t test, and we applied the Chi-square or Fischer exact test for binary variables. A threshold of p < 0.05 was set for statistical signi cance.Results. We included 50 pediatric patients (0.2 -17.6 years old). 40/50 lesions showed SF uptake (80%).The differentiation between healthy and affected tissue, thanks to SF, subjectively evaluated by the surgeon, had as objective counterpart the statistically signi cant higher brightness of green in lesions, registered by the software (p < 0.001). SF overall allowed a good differentiation in 33/50 lesions, and overall utility of SF has been noted in 67% of them. When speci cally considering gliomas, overall utility reached 75%.Conclusion. SF is a feasible, safe and useful intraoperative adjunct in pediatric neurosurgery. In particular, it seems to have a promising role in some low-grade in ltrating glial tumors. The subjective evaluation of uorescence seems to be reliable with respect to image analyses software.

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Section: Discussionsupporting

confidence: 78%

Sodium fluorescein in pediatric oncological neurosurgery: a pilot study on 50 children

et al. 2022

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“…In the literature, different cases of adverse reactions have been reported, but interestingly they either involve high dosages of SF [ 25 ] and/or intrathecal injection [ 26 , 27 , 28 ]. No serious adverse events have been reported so far in a pediatric population [ 21 , 29 , 30 ], as shown in our LGGs series.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Low-Grade Glioma Surgery with Sodium Fluorescein: Efficient Localization for Removal and Association with Intraoperative Pathological Sampling

et al. 2022

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Low-grade gliomas are among the most common CNS lesions in pediatrics and surgery is often the first-line treatment. Intraoperative tools have been developed to maximize the results of surgery, and in particular dyes such as sodium fluorescein (SF) have been investigated in high-grade adult lesions. The use of SF in pediatric low-grade gliomas is still unclear. We retrospectively reviewed 22 pediatric CNS low-grade gliomas operated on with SF from September 2021 to October 2022. A total of 86% of lesions showed SF uptake, which was helpful intraoperatively (confirmation of initial localization of the tumor, or identification of tumor remnants) in 74% of them. The intraoperative fluorescence seems associated with gadolinium enhancement at the preoperative MRI. Interestingly, the extemporaneous pathological sampling (EPS) was informative in every case showing SF uptake, whereas in cases without SF uptake, the EPS was non-informative, although the tissue was later confirmed as pathological. These findings highlight the interest of SF for perioperative diagnosis of tumor tissue and may suggest in which cases the differentiation of tumor–healthy tissue could be especially blurred, posing difficulties for the pathologist.

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“…While most fluorescein is eliminated after 24 h, it can be traced in urine up to a week after its infusion. [6][7][8][18][19][20][21][22][23][24][25] Sym et al 16 found that the onset of complications appeared to be dose dependent and proposed that the changes induced by chemical trauma likely explain the neurologic symptoms. 10 The blue-light filter, which is sensitive to dilutions of up to 1 in 10 million of fluorescein, is employed when the CSF leak is not readily visible under white light, providing fluorescent excitation.…”

Section: Discussionmentioning

confidence: 99%

“…Although IF injection is usually considered a safe procedure, 12 several studies report complications such as generalized tonic-clonic or absent seizures, status epilepticus, coma, paresthesia and paraplegia of the lower limbs, deficits of cranial nerves, headache, and aseptic meningitis. [6][7][8][18][19][20][21][22][23][24][25] Sym et al 16 found that the onset of complications appeared to be dose dependent and proposed that the changes induced by chemical trauma likely explain the neurologic symptoms. This observation is consistent with the findings of large multiple series, which show that higher IF doses correlated with greater neurologic harm.…”

Section: Discussionmentioning

confidence: 99%

The use of intrathecal fluorescein in cerebrospinal fluid leak repair: management from an anesthesiologist's point‐of‐view

Antunes

Perdigão

2016

Acta Anaesthesiol Scand

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A Case of Myelopathy after Intrathecal Injection of Fluorescein

Cited by 15 publications

References 11 publications

Sodium fluorescein in pediatric oncological neurosurgery: a pilot study on 50 children

Sodium fluorescein in pediatric oncological neurosurgery: a pilot study on 50 children

Pediatric Low-Grade Glioma Surgery with Sodium Fluorescein: Efficient Localization for Removal and Association with Intraoperative Pathological Sampling

The use of intrathecal fluorescein in cerebrospinal fluid leak repair: management from an anesthesiologist's point‐of‐view

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