Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future projects

Schebesch, Karl‐Michael; Brawanski, Alexander; Hohenberger, Christoph; Höhne, Julius

doi:10.5137/1019-5149.jtn.16952-16.0

Cited by 46 publications

(44 citation statements)

References 48 publications

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“…The use of FL in combination with the 560 nm filter and the PENTERO microscope for parotidectomy was a logical conclusion. The fluorophore FL has been well known in ophthalmic surgery for almost five decades and has become established in neuro-oncologic surgery since the late 1990s [12]. The fluorescent staining of brain tumors is explained by to the lack of normal blood–brain barrier function [13].…”

Section: Discussionmentioning

confidence: 99%

“…The fluorescent staining of brain tumors is explained by to the lack of normal blood–brain barrier function [13]. Exposure to yellow- filtered light with a wavelength of about 560 nm significantly increases the color intensity of FL [12]. …”

Section: Discussionmentioning

confidence: 99%

“…In the present case series of patients with parotid gland tumors also no adverse effects were observed. However, the immediate but transient yellow discoloration of the skin and the urine is consistently described in the literature [12]. Patients have to be informed and consented.…”

Section: Discussionmentioning

confidence: 99%

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Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance

Haubner¹,

Gassner²,

Brawanski

et al. 2017

BMC Ear Nose Throat Disord

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BackgroundComplete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor tissue and allows to identify residual tumor tissue could be Fluorescein Sodium.MethodsRetrospective chart analysis on 7 patients with benign parotid gland lesions that were operated using Fluorescein Sodium intravenously and the application of the YELLOW 560 nm filter of the operating microscope. Safety and feasibility were evaluated.ResultsAll tumors showed fluorescence and the rating ´contrast-enhancing´ was assigned in all cases. In 2 patients, satellite nodules were identified and resected meaning that the fluorescence staining of the tumor margins was significantly better than under white light.ConclusionThe use of Fluorescein Sodium in parotidectomy is promising. In two cases residual tumor was detected that would have been left behind under white light. Further research in parotid gland surgery and other head and neck tumor procedures is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance

Haubner¹,

Gassner²,

Brawanski

et al. 2017

BMC Ear Nose Throat Disord

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“…[4][5][6][7] The primary advantage of fluorescence-guided surgery is to facilitate the resection by demarcating the tumor margin from the normal brain tissue in real time, with relatively easy preparation and low cost. 8,9 In this retrospective study, we report the first experiences using sodium fluorescein in pediatric patients with BsG. The major goal of the study is to analyze the safety and effectiveness of this approach.…”

Section: Introductionmentioning

confidence: 99%

Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

et al. 2018

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Brainstem gliomas (BsG) account for 10 to 15% of pediatric brain tumors. Surgery is the preferred treatment for focal and exophytic lesions. Sodium fluorescein has been proven safe and effective in resection of malignant brain tumors. The objective was to o analyze the safety and effectiveness of this approach, to evaluate intraoperative fluorescein imaging, and to measure the safety of chosen dose for pediatric patients. Twelve cases were enrolled between March 2014 and September 2016 in Beijing Tiantan Hospital. All of the patients received 2.5 mg/kg of sodium fluorescein before opening the dura; the intraoperative fluorescence enhancement was observed, and the degree of satisfaction and consistency with the neuronavigation were evaluated. With a mean age of 7.5 years, there were eight cases located within the pontine, three in the medullary oblongata, and one in the tectal plate. Histological results were astrocytoma, glioblastoma, oligodendroglioma, and pilocytic astrocytoma. Under the fluorescein module of the microscope, the tumors were recognizable enough to help surgeons to discriminate the lesion from non-fluorescent tissue, with a consistency of 83% with the neuronavigation. Total removal was accomplished in nine cases, while the mean percentage of resection of the other cases was 93.7%. The Karnofsky performance score (KPS) showed no significant differences between pre-operation and discharge, but there was a difference between pre-operation and 6-month follow-up. The fluorescein-guided surgery is useful for demarcating the tumor margin and works well with other navigation and monitoring devices. A safe dose of sodium fluorescein (2.5 mg/kg) was proven effective for children.

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“…[7] Immediately after intravenous administration, FL accumulates in the disrupted blood–brain barrier (BBB) resulting in the dose-dependent visualization of the area of increased vascular permeability. This effect can be intensified by the use of a dedicated light source and filter (“YE560,” YELLOW 560 nm Filter, Carl Zeiss Meditec, Oberkochen) integrated into the PENTERO 900 surgical microscope (Carl Zeiss Meditec, Oberkochen).…”

Section: Introductionmentioning

confidence: 99%

Fluorescein sodium-guided surgery of a brain abscess: A case report

Höhne¹,

Brawanski²,

Schebesch³

2016

Surg Neurol Int

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Background:Up to now, the feasibility and benefit of using fluorescein sodium under a dedicated surgical microscope filter (YE560, YELLOW 560 nm filter, Carl Zeiss Meditec, Germany) has never been clinically evaluated in infectious disorders of the brain.Case Description:Here, we report the case of a male patient with a brain abscess in the right parietal lobe that was removed under fluorescence-guidance (intravenous administration of fluorescein sodium 10%, 5 mg/kg bodyweight). The abscess capsule showed intensive yellow fluorescent staining, while − under white light − the cortex appeared normal.Conclusion:This technique may improve the identification and surgical removal of brain abscesses.

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Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future projects

Cited by 46 publications

References 48 publications

Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance

Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance

Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

Fluorescein sodium-guided surgery of a brain abscess: A case report

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