Sodium Fluorescein–Guided Surgery in Peripheral Nerve Sheath Tumors: First Experience in 10 Cases of Schwannoma

Pedro, Maria Teresa; Eissler, Alexandra; Schmidberger, Julian; Kratzer, Wolfgang; Wirtz, Christian Rainer; Antoniadis, Gregor; Koenig, Ralph Werner

doi:10.1016/j.wneu.2019.01.010

Cited by 21 publications

(8 citation statements)

References 16 publications

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“…Nevertheless, we noted that the most relevant advantage of SF was obtained mainly in neurofibromas helping identify diffuse tumor remnants (Figure 3). The German group led by Pedro found similar results: the authors examined 21 cases of PNST during surgery under SF at the low dosage of 0.5-1mg/kg (22,23). An optimal distinction between tumor and surrounding nerves was observed in all 17 schwannomas scheduled for fluorescein-guided surgery, in 1 neurofibroma, and 1 MPNST.…”

Section: Discussionmentioning

confidence: 71%

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Assessing the role of sodium fluorescein in peripheral nerve sheath tumors and mimicking lesions surgery: An update after 142 cases

et al. 2023

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ObjectivePeripheral nerve sheath tumors (PNST) include mainly schwannomas and neurofibromas. Surgical resection represents the mainstay of treatment but due to their pathogenesis, distinguishing between intact functional nerve and the fibers from whence the PNST arose may not always be easy to perform, constituting the most relevant risk factor in determining a worsening in neurological condition. The introduction of intraoperative tools to better visualize these tumors could help achieve a gross-total resection. In this study, we analyzed the effect of sodium fluorescein (SF) on the visualization and resection of a large cohort of PNST.MethodsBetween September 2018 and December 2021, 142 consecutive patients harboring a suspected PNST underwent fluorescein-guided surgery at the Department of Neurosurgery of the Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. All patients presented with a different degree of contrast enhancement at preoperative MRI. SF was intravenously injected after intubation at 1 mg/kg. Intraoperative fluorescein characteristics and postoperative neurological and radiological outcomes were collected, analyzed, and retrospectively compared with a historical series.Results142 patients were included (42 syndromic and 100 sporadic); schwannoma was the predominant histology, followed by neurofibroma (17 neurofibroma e 12 plexiform neurofibroma) and MPNST. Bright fluorescence was present in all cases of schwannomas and neurofibromas, although with a less homogeneous pattern, whereas it was significantly less evident for malignant PNST; perineurioma and hybrid nerve sheath tumors were characterized by a faint fluorescence enhancement. The surgical resection rate in the general population and even among the subgroups was about 66.7%; from the comparative analysis, we found a consistently higher rate of complete tumor removal in plexiform neurofibromas, 66% in the “fluorescent” group vs 44% in the “historical” group (p-value < 0.05). The rate of complications and mean surgical time were superimposable among the two populations.ConclusionsSF is a valuable method for safe fluorescence-guided PNST and mimicking lesions resection. Our data showed a positive effect of fluorescein-guided surgery in increasing the rate of surgical resection of plexiform neurofibromas, suggesting a possible role in improving the functional and oncological outcome of these lesions.

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Section: Discussionmentioning

confidence: 71%

“…The potential role of SF in PNST surgery is still little explored, despite some preliminary clinical reports ( 22 – 25 ). Experimental models have demonstrated that SF causes endoneurial extravasation, like blood-brain barrier extravasation, confirming the behavior of fluorescein as an unspecific vascular dye ( 26 – 28 ).…”

Section: Introductionmentioning

confidence: 99%

Assessing the role of sodium fluorescein in peripheral nerve sheath tumors and mimicking lesions surgery: An update after 142 cases

et al. 2023

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“…Its first application within surgery was in the identification of brain tumours in 1948 [14], and is in fact still used for the same purpose in neurosurgery today in identifying various types of brain tumour. Fluorescein sodium is also commonly used in ophthalmic angiography for visualising the retina, with new uses in surgery and clinical procedures also being investigated including its use in detecting oral dysplasia and oral cancer [51], as an aide in detecting spinal dural arteriovenous fistulas [52] as well as its feasibility in identifying peripheral nerve sheath tumours during microsurgical removal [53].…”

Section: Extrinsic Probesmentioning

confidence: 99%

Fluorescence Guided Surgery

Stewart

Birch

2021

Methods Appl. Fluoresc.

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Fluorescence guided surgery (FGS) is an imaging technique that allows the surgeon to visualise different structures and types of tissue during a surgical procedure that may not be as visible under white light conditions. Due to the many potential advantages of fluorescence guided surgery compared to more traditional clinical imaging techniques such as its higher contrast and sensitivity, less subjective use, and ease of instrument operation, the research interest in fluorescence guided surgery continues to grow over various key aspects such as fluorescent probe development and surgical system development as well as its potential clinical applications. This review looks to summarise some of the emerging opportunities and developments that have already been made in fluorescence guided surgery in recent years while highlighting its advantages as well as limitations that need to be overcome in order to utilise the full potential of fluorescence within the surgical environment.

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“…Meanwhile, brain tumor varieties are numerous and distinct. Some tumors are problematic to scrutinize, such as schwannoma [2]; others are challenging to locate, such as glioma and glioblastoma [3]. In addition, lung nodules, i.e., sarcoidosis, are a multi-system and multi-organ granulomatous disease of unknown etiology.…”

Section: Introductionmentioning

confidence: 99%

Symmetry GAN Detection Network: An Automatic One-Stage High-Accuracy Detection Network for Various Types of Lesions on CT Images

Zhang

et al. 2022

Symmetry

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Computed tomography (CT) is the first modern slice-imaging modality. Recent years have witnessed its widespread application and improvement in detecting and diagnosing related lesions. Nonetheless, there are several difficulties in detecting lesions in CT images: (1) image quality degrades as the radiation dose is reduced to decrease radiational injury to the human body; (2) image quality is frequently hampered by noise interference; (3) because of the complicated circumstances of diseased tissue, lesion pictures typically show complex shapes; (4) the difference between the orientated object and the background is not discernible. This paper proposes a symmetry GAN detection network based on a one-stage detection network to tackle the challenges mentioned above. This paper employs the DeepLesion dataset, containing 10,594 CT scans (studies) of 4427 unique patients. The symmetry GANs proposed in this research consist of two distinct GAN models that serve different functions. A generative model is introduced ahead of the backbone to increase the input CT image series to address the typical problem of small sample size in medical datasets. Afterward, GAN models are added to the attention extraction module to generate attention masks. Furthermore, experimental data indicate that this strategy has significantly improved the model’s robustness. Eventually, the proposed method reaches 0.9720, 0.9858, and 0.9833 on P, R, and mAP, on the validation set. The experimental outcome shows that the suggested model outperforms other comparison models. In addition to this innovation, we are inspired by the innovation of the ResNet model in terms of network depth. Thus, we propose parallel multi-activation functions, an optimization method in the network width. It is theoretically proven that by adding coefficients to each base activation function and performing a softmax function on all coefficients, parallel multi-activation functions can express a single activation function, which is a unique ability compared to others. Ultimately, our model outperforms all comparison models in terms of P, R, and mAP, achieving 0.9737, 0.9845, and 0.9841. In addition, we encapsulate the model and build a related iOS application to make the model more applicable. The suggested model also won the second prize in the 2021 Chinese Collegiate Computing Competition.

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Sodium Fluorescein–Guided Surgery in Peripheral Nerve Sheath Tumors: First Experience in 10 Cases of Schwannoma

Cited by 21 publications

References 16 publications

Assessing the role of sodium fluorescein in peripheral nerve sheath tumors and mimicking lesions surgery: An update after 142 cases

Assessing the role of sodium fluorescein in peripheral nerve sheath tumors and mimicking lesions surgery: An update after 142 cases

Fluorescence Guided Surgery

Symmetry GAN Detection Network: An Automatic One-Stage High-Accuracy Detection Network for Various Types of Lesions on CT Images

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