The utilization of fluorescein in brain tumor surgery: a systematic review

Cavallo, Claudio; Laurentis, Camilla de; Vetrano, Ignazio G.; Falco, Jacopo; Broggi, Morgan; Schiariti, Marco; Ferroli, Paolo; Acerbi, Francesco

doi:10.23736/s0390-5616.18.04480-6

Cited by 44 publications

(44 citation statements)

References 63 publications

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“…In all these cases, SF appeared extremely useful to improve the discrimination between tumor tissue and peritumoral brain parenchyma, with a positive impact in term of EOR, with a percentage of GTR in 74.2%. Coming from an unselected series of patients, these results seems to be extremely interesting, and in line with previous published studies (32, 33, 38, 39, 59).…”

Section: Discussionsupporting

confidence: 89%

“…This was also associated with good results in term of extent of resection (39). However, there were in the literature significant variations in SF use, considering dosage and time of injections, in the studies published by different research groups (39).…”

Section: Discussionmentioning

confidence: 89%

“…In fact, independently from their grading, the majority of CNS tumors, except for some grade I and II intra-axial histotypes, determine a BBB damage, thus they have a radiological presentation with contrast enhancement at MRI. Previous experiences had suggested that the use SF could be associated with a bright fluorescence of the tumor area in primary and recurrent HGG, in metastases, in lymphomas, and in spinal intramedullary lesions (34–36, 39). This was also associated with good results in term of extent of resection (39).…”

Section: Discussionmentioning

confidence: 99%

“…Previous experiences had suggested that the use SF could be associated with a bright fluorescence of the tumor area in primary and recurrent HGG, in metastases, in lymphomas, and in spinal intramedullary lesions (34–36, 39). This was also associated with good results in term of extent of resection (39). However, there were in the literature significant variations in SF use, considering dosage and time of injections, in the studies published by different research groups (39).…”

Section: Discussionmentioning

confidence: 99%

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Fluorescein Application in Cranial and Spinal Tumors Enhancing at Preoperative MRI and Operated With a Dedicated Filter on the Surgical Microscope: Preliminary Results in 279 Patients Enrolled in the FLUOCERTUM Prospective Study

et al. 2019

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Objective: Sodium fluorescein, a green, water soluble dye, is used as neurosurgical fluorescent tracer thanks to its property to accumulate in cerebral regions of blood-brain barrier (BBB) disruption. The authors report the preliminary results of a prospective observational study regarding the use of fluorescein-guided technique for the resection of suspected malignant neoplasms of the central nervous system (CNS), contrast enhancing at preoperative magnetic resonance imaging (MRI), using a dedicated filter on the surgical microscope. Methods: In March 2016 the authors started a prospective, observational trial to evaluate intraoperative fluorescence's characteristics of CNS tumors, the percentage of extent of resection thanks to fluorescein aid and side effects related to fluorescein administration. This report is based on a preliminary analysis of the results of first 279 enrolled patients. Fluorescein was intravenously injected after intubation or immediately at the entrance in the operating room for awake procedures; the tumor was removed using a dedicated filter on the surgical microscope in an inside-out fashion until all fluorescent tissue was removed, as considered feasible by the surgeon. Results: The 279 patients finally enrolled in the trial, both firstly diagnosed and recurrent, were categorized according to WHO pathological classification and there were 212 neuroepithelial tumors, 25 brain metastases, 10 cerebral lymphomas, 7 hemangioblastomas, or hemangioendotheliomas and 25 other tumors and conditions. No adverse reaction related to the administration of fluorescein or to the combined use of fluorescein with other fluorophores was registered. Fluorescein accumulated in cerebral regions where the BBB was damaged, representing a significant surgical aid in most of the CNS tumors with contrast enhancement. In cases of complete removal of all fluorescent tissue, as intraoperatively judged by the surgeon, postoperative MRI revealed a gross total resection in 181/198 patients (91.4%). Conclusions: Based on these preliminary results, fluorescein-guided surgery with a dedicated filter on the microscope is a safe and effective technique to improve visualization and resection of different CNS tumors and conditions, based on BBB alteration.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Fluorescein Application in Cranial and Spinal Tumors Enhancing at Preoperative MRI and Operated With a Dedicated Filter on the Surgical Microscope: Preliminary Results in 279 Patients Enrolled in the FLUOCERTUM Prospective Study

et al. 2019

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“…Aside from 5-ALA other fluorophores were additionally investigated for fluorescence guided resection in HGG as well as LGG. One alternative to 5-ALA for intraoperative fluorescence represents sodium fluorescein (134)(135)(136)(137). Sodium fluorescein is a technique for intraoperative fluorescence-guided resection in HGG, however, it showed no benefit in LGG surgery as no intraoperative yellow fluorescence was evident in LGG tissue (138,139).…”

Section: Value Of Other Fluorophores In Lggmentioning

confidence: 99%

5-ALA in Suspected Low-Grade Gliomas: Current Role, Limitations, and New Approaches

et al. 2021

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Radiologically suspected low-grade gliomas (LGG) represent a special challenge for the neurosurgeon during surgery due to their histopathological heterogeneity and indefinite tumor margin. Therefore, new techniques are required to overcome these current surgical drawbacks. Intraoperative visualization of brain tumors with assistance of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence is one of the major advancements in the neurosurgical field in the last decades. Initially, this technique was exclusively applied for fluorescence-guided surgery of high-grade glioma (HGG). In the last years, the use of 5-ALA was also extended to other indications such as radiologically suspected LGG. Here, we discuss the current role of 5-ALA for intraoperative visualization of focal malignant transformation within suspected LGG. Furthermore, we discuss the current limitations of the 5-ALA technology in pure LGG which usually cannot be visualized by visible fluorescence. Finally, we introduce new approaches based on fluorescence technology for improved detection of pure LGG tissue such as spectroscopic PpIX quantification fluorescence lifetime imaging of PpIX and confocal microscopy to optimize surgery.

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Chemical Artificial Internalizing Receptors for Primary T Cells

et al. 2020

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The newest generation of cell‐based technologies relies heavily on methods to communicate to the engineered cells using artificial receptors, specifically to deactivate the cells administered to a patient in the event of adverse effects. Herein, artificial synthetic internalizing receptors are engineered that function in mammalian cells in 2D and in 3D and afford targeted, specific intracellular drug delivery with nanomolar potency in the most challenging cell type, namely primary, donor‐derived T cells. Receptor design comprises a lipid bilayer anchor for receptor integration into cell membrane and a small xenobiotic molecule as a recognition ligand. Artificial receptors are successfully targeted by the corresponding antibody–drug conjugate (ADC) and exhibit efficient cargo cell entry with ensuing intracellular effects. Receptor integration into cells is fast and robust and affords targeted cell entry in under 2 h. Through a combination of the receptor design and the use of ADC, combined benefits previously made available by chimeric artificial receptors (performance in T cells) and the chemical counterpart (robustness and simplicity) in a single functional platform is achieved. Artificial synthetic receptors are poised to facilitate the maturation of engineered cells as tools of biotechnology and biomedicine.

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The utilization of fluorescein in brain tumor surgery: a systematic review

Cited by 44 publications

References 63 publications

Fluorescein Application in Cranial and Spinal Tumors Enhancing at Preoperative MRI and Operated With a Dedicated Filter on the Surgical Microscope: Preliminary Results in 279 Patients Enrolled in the FLUOCERTUM Prospective Study

Fluorescein Application in Cranial and Spinal Tumors Enhancing at Preoperative MRI and Operated With a Dedicated Filter on the Surgical Microscope: Preliminary Results in 279 Patients Enrolled in the FLUOCERTUM Prospective Study

5-ALA in Suspected Low-Grade Gliomas: Current Role, Limitations, and New Approaches

Chemical Artificial Internalizing Receptors for Primary T Cells

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