Does fluorescein sodium-guided resection of cerebral metastases increase rates of total resections?

Abstract

In their article BFluorescein sodium-guided resection of cerebral metastases-experience with the first 30 patients^, Schebesch and colleagues examine the use of fluorescein sodium dye in patients harboring brain metastases. In their retrospective patient series, 30 patients with different tumor entities were included. All patients underwent surgical resection of brain metastasis while using fluorescein sodium and a YELLOW 560 nm (ZEISS) filter. According to them, sufficient fluorescent staining was observed in 27 patients and complete tumor resection in 25 patients.Their findings are in accordance with a prior study conducted by Okuda and colleagues [1], though Okuda and colleagues used fluorescein sodium under white light without a particular microscope filter.While of course their retrospective study permits no conclusion that the use of fluorescein sodium will help to improve the neurosurgical treatment of patients with brain metastases in regard to the extent of resection and local control rate, we consider their study an important step in the right direction.Cerebral metastases are a very common problem and many more patients suffer from brain metastases than intrinsic brain tumors. Due to significant improvements in cancer therapies and imaging techniques, more and more patients are eligible for a neurosurgical treatment.Therefore it is the neurosurgeon's challenge to improve the surgical treatment of these patients as well. As long as local control rates are comparably low and the extent of resection in patients with brain metastases is well below the desirable 100 %, new techniques should be introduced, and of course tested for their validity, particularly since the use of fluorescent staining in neurosurgery is well established for highgrade gliomas for almost 10 years now [2].So far we only know that most metastases shine yellow. This is good, but only the first step. A properly designed trial seems necessary, in which rate of resection and the role of supramarginal resection is addressed.

The Effects of Sodium Fluorescein Dyeing of Metastatic Brain Tumors on Surgical Outcomes under Microsurgical Operation

“…In addition to these, total resection and mini- mental testing of the patient, namely memory and cognitive functions. are also associated with good prognosis 13,17 . In brain tumor surgery, the surgeon should ensure that these prognostic factors do not change.…”

“…Side effects, up to anaphylaxis, have been avoided by using low doses of 3-4 mg/kg, thanks to filters that give a yellow highlight to FL at a wavelength of 560 nm, which have recently been installed on surgical microscopes 12 . There are studies showing that the use of FL in brain metastases increases the amount of resection 13,14 . We will also present the results, surgical differences and our experience in patients with brain metastases in which we used and did not use FL staining with a 560 nm filter microscope in surgery.…”