An Anaphylactoid Reaction After Administration of Fluorescein Sodium During Neurosurgery

Tanahashi, Shigeaki; lida, Hiroki; Dohi, Shuji

doi:10.1213/01.ane.0000227205.37935.10

Cited by 46 publications

(29 citation statements)

References 3 publications

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“…The skin, mucosa and urine were stained yellow, but this was transient, disappearing completely within 24 hours postoperatively. Anaphylactic shock has been reported as a serious side effect, but it is rare 20 and was not observed in the present study. As an additional advantage, fluorescein sodium is inexpensive and comparatively easy to use, and does not require any special equipment.…”

Section: Discussioncontrasting

confidence: 64%

Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium

Okuda

Kataoka

Yabuuchi

et al. 2010

Journal of Clinical Neuroscience

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Section: Discussioncontrasting

confidence: 64%

Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium

Okuda

Kataoka

Yabuuchi

et al. 2010

Journal of Clinical Neuroscience

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“…This could be related both to the fact that fluorescein was mainly administered to intubated patients under general anesthesia and to the use of low-dosage compared with that used in ophthalmology or in the first neurosurgic experiences without a specific filter on the surgical microscope. In fact, only two cases of anaphylactic reactions in neurosurgical application were reported in the scientific literature, all of them with a dosage of 20 mg/kg (33)(34). Our data on primary endpoints showed a complete resection in 82.6% of the cases, with a median RV in the remaining cases of 0.1945 cm 3 .…”

Section: Discussionmentioning

confidence: 58%

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Acerbi

Broggi

Schebesch

et al. 2018

Clinical Cancer Research

180

145

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Purpose: Sodium fluorescein is a dye that, intravenously injected, selectively accumulates in high-grade glioma (HGG) tissue through a damaged blood-brain barrier. In this article, the final results of a multicentric prospective phase II trial (FLUO-GLIO) on fluorescein-guided HGG resection through a dedicated filter on the surgical microscope were reported.Methods: Patients with suspected HGGs considered suitable for removal were eligible to participate in this trial. Fluorescein was intravenously injected at a dose of 5 to 10 mg/kg. The primary endpoint was the percentage of patients with histologically confirmed HGGs, without contrast-enhancing tumor at the immediate postoperative MRI. Secondary endpoints were PFS, residual tumor on postoperative MRI, overall survival, neurologic deficits, and fluorescein-related toxicity. The sensitivity and specificity of fluorescein in identifying tumor tissue were estimated by fluorescent and nonfluorescent biopsies at the tumor margin. The study was registered on the European Regulatory Authorities website (EudraCT 2011-002527-18).Results: Fifty-seven patients aged 45 to 75 years were screened for participation, and 46 were considered for primary and secondary endpoints. Mean preoperative tumor volume was 28.75 cm 3 (range, 1.3-87.8 cm 3 ). Thirty-eight patients (82.6%) underwent a complete tumor removal. Median follow-up was 11 months. PFS-6 and PFS-12 were 56.6% and 15.2%. Median survival was 12 months. No adverse reaction related to SF administration was recorded. The sensitivity and specificity of fluorescein in identifying tumor tissue were respectively 80.8% and 79.1%.Conclusions: Fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and enables a high percentage of contrast-enhancing tumor in patients with HGGs.

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“…This might be related also to the use of specific filters that enable reduction of the total dose of fluorescein injected 1,8,18 with a possible impact on reduction of side effects. Rare adverse events, including anaphylactic reactions, after fluorescein injection have been reported in the ophthalmological and neurosurgical literature, 3,9,10,16,28,33 but no side effects were registered with the use of low-dose fluorescein in more recent pa- pers. In addition, it should be noticed that in neurosurgical applications, side effects may be even less frequent than in ophthalmological cases due to the fact that fluorescein is administered with the patient intubated in a state of general anesthesia.…”

Section: Discussionmentioning

confidence: 96%

Is fluorescein-guided technique able to help in resection of high-grade gliomas?

Acerbi¹,

Broggi²,

Eoli

et al. 2014

FOC

150

114

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Object Fluorescein, a dye that is widely used as a fluorescent tracer, accumulates in cerebral areas where the blood-brain barrier is damaged. This quality makes it an ideal dye for the intraoperative visualization of high-grade gliomas (HGGs). The authors report their experience with a new fluorescein-guided technique for the resection of HGGs using a dedicated filter on the surgical microscope. Methods The authors initiated a prospective Phase II trial (FLUOGLIO) in September 2011 with the objective of evaluating the safety of fluorescein-guided surgery for HGGs and obtaining preliminary evidence regarding its efficacy for this purpose. To be eligible for participation in the study, a patient had to have suspected HGG amenable to complete resection of the contrast-enhancing area. The present report is based on the analysis of the short- and long-term results in 20 consecutive patients with HGGs (age range 45–74 years), enrolled in the study since September 2011. In all cases fluorescein (5–10 mg/kg) was injected intravenously after intubation. Tumor resection was performed with microsurgical technique and fluorescence visualization by means of BLUE 400 or YELLOW 560 filters on a Pentero microscope. Results The median preoperative tumor volume was 30.3 cm3 (range 2.4–87.8 cm3). There were no adverse reactions related to fluorescein administration. Complete removal of contrast-enhanced tumor was achieved in 80% of the patients. The median duration of follow-up was 10 months. The 6-months progression-free survival rate was 71.4% and the median survival was 11 months. Conclusions Analysis of these 20 cases suggested that fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows a high rate of complete resection of contrast-enhanced tumor as determined on early postoperative MRI. Clinical trial registration no.: 2011-002527-18 (EudraCT).

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An Anaphylactoid Reaction After Administration of Fluorescein Sodium During Neurosurgery

Cited by 46 publications

References 3 publications

Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium

Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium

Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)

Is fluorescein-guided technique able to help in resection of high-grade gliomas?

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