Metastatic Brain Tumor Surgery Using Fluorescein Sodium: Technical Note

Okuda, Takeshi; Kataoka, Keisuke; Taneda, M

doi:10.1055/s-2007-993200

Cited by 34 publications

(23 citation statements)

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“…Tumors detected on imaging findings are thus stained, with no tumor specificity. 9 In the present study we found no differences in staining intensity among the metastases of different types of primary cancer.…”

Section: Discussioncontrasting

confidence: 59%

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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: 59%

“…Thus, to achieve further improvements in local control, we have assessed the use of fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium. 9 2. Methods and patients…”

Section: Introductionmentioning

confidence: 99%

Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium

Okuda

Kataoka

Yabuuchi

et al. 2010

Journal of Clinical Neuroscience

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“…[1053707492] One study reported that gross total resection (GTR) of GBM was achieved in 84.4% of patients who received fluorescein compared with only 30.1% of patients who did not. [92] These results were reproduced in a prospective study;[53] however, it should be noted that both studies failed to show a significant survival benefit despite higher rates of GTR in patients who received fluorescein.…”

Section: Fluorescein Sodiummentioning

confidence: 99%

Neurosurgical confocal endomicroscopy: A review of contrast agents, confocal systems, and future imaging modalities

et al. 2014

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Background:The clinical application of fluorescent contrast agents (fluorescein, indocyanine green, and aminolevulinic acid) with intraoperative microscopy has led to advances in intraoperative brain tumor imaging. Their properties, mechanism of action, history of use, and safety are analyzed in this report along with a review of current laser scanning confocal endomicroscopy systems. Additional imaging modalities with potential neurosurgical utility are also analyzed.Methods:A comprehensive literature search was performed utilizing PubMed and key words: In vivo confocal microscopy, confocal endomicroscopy, fluorescence imaging, in vivo diagnostics/neoplasm, in vivo molecular imaging, and optical imaging. Articles were reviewed that discussed clinically available fluorophores in neurosurgery, confocal endomicroscopy instrumentation, confocal microscopy systems, and intraoperative cancer diagnostics.Results:Current clinically available fluorescent contrast agents have specific properties that provide microscopic delineation of tumors when imaged with laser scanning confocal endomicroscopes. Other imaging modalities such as coherent anti-Stokes Raman scattering (CARS) microscopy, confocal reflectance microscopy, fluorescent lifetime imaging (FLIM), two-photon microscopy, and second harmonic generation may also have potential in neurosurgical applications.Conclusion:In addition to guiding tumor resection, intraoperative fluorescence and microscopy have the potential to facilitate tumor identification and complement frozen section analysis during surgery by providing real-time histological assessment. Further research, including clinical trials, is necessary to test the efficacy of fluorescent contrast agents and optical imaging instrumentation in order to establish their role in neurosurgery.

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“…This small dose is 15% of the dose previously used for neoplastic and vascular applications. 3,5,9,15,22,24 We chose this dose based on our previous experience. We had decreased fluorescein dosing gradually from 200 mg in 25 increments for the previous 10 patients who harbored brain aneurysms.…”

Section: Technique For Fluorescence Angiographymentioning

confidence: 99%

A prospective study of microscope-integrated intraoperative fluorescein videoangiography during arteriovenous malformation surgery: preliminary results

Lane

Cohen-Gadol

2014

FOC

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Object The authors report on the use of a recently developed microscope-integrated fluorescent module using low-dose intravenous fluorescein for videoangiography during arteriovenous malformation (AVM) surgery. Methods The authors analyzed the application of a low-dose intraoperative fluorescein in 4 consecutive patients undergoing AVM surgery. The ability to distinguish the associated vessels of the AVM from normal vessels and to assess the degree of AVM obliteration based on videoangiography of venous drainage was specifically analyzed. Results All 4 patients underwent fluorescein angiography without complication. In each case, videoangiography confirmed recognition of feeding arteries and draining veins through the operating oculars under the fluorescent mode. In one case involving a large frontal AVM, videoangiography demonstrated mainly cortical veins on the surface of the AVM and alerted the senior author to first tackle the feeding arteries in the interhemispheric space. While evaluating the flow within the different draining veins after most of the AVM was disconnected, videoangiography also prioritized the order for disconnection of large draining veins to allow mobilization the AVM and exposure of the remaining deep arterial feeders. In the other 3 cases, videoangiography allowed easy recognition of the angioarchitecture of the AVMs, estimated its cortical boundaries, and most importantly, assessed the flow within the draining veins before their disconnection. Conclusions The authors found fluorescein videoangiography to be a useful adjunct in resection of AVMs. This technology offers the unique ability to visualize fluorescent vessels and nonfluorescent tissues in near-natural colors simultaneously and permits microsurgical manipulation of relevant structures under the fluorescent mode. Largerscale studies are needed to establish its efficacy and wider applicability.

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Metastatic Brain Tumor Surgery Using Fluorescein Sodium: Technical Note

Cited by 34 publications

References 0 publications

Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium

Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium

Neurosurgical confocal endomicroscopy: A review of contrast agents, confocal systems, and future imaging modalities

A prospective study of microscope-integrated intraoperative fluorescein videoangiography during arteriovenous malformation surgery: preliminary results

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