Fluorescein-guided resection of cerebral metastases is associated with greater tumor resection

Background Sodium fluorescein (fluorescein) crosses a disrupted blood-brain barrier similarly to gadolinium contrast in contrast-enhancing cerebral tumors. When exposed to light with 560 nm wavelength during surgery, fluorescein emits a yellow-green fluorescent light that can be visualized through a...

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Bibliographic Details
Published in:Acta neurochirurgica 2022-02, Vol.164 (2), p.451-457
Main Authors: Kofoed, Mikkel S., Pedersen, Christian B., Schulz, Mette K., Kristensen, Bjarne W., Hansen, Rasmus W., Markovic, Ljubo, Halle, Bo, Poulsen, Frantz R.
Format: Article
Language:English
Subjects:
Blood-brain barrier
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - pathology
Brain Neoplasms - surgery
Fluorescein
Fluorescent Dyes
Gadolinium
Humans
Interventional Radiology
Magnetic resonance imaging
Medicine
Medicine & Public Health
Metastases
Metastasis
Minimally Invasive Surgery
Neurological complications
Neurology
Neuroradiology
Neurosurgery
Neurosurgical Procedures
Original Article - Tumor - Other
Patients
Retrospective Studies
Supratentorial Neoplasms - surgery
Surgery
Surgical Orthopedics
Tumor – Other
Tumors
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Summary:Background Sodium fluorescein (fluorescein) crosses a disrupted blood-brain barrier similarly to gadolinium contrast in contrast-enhancing cerebral tumors. When exposed to light with 560 nm wavelength during surgery, fluorescein emits a yellow-green fluorescent light that can be visualized through an operating microscope equipped with an appropriate emission filter. The distribution of the fluorescence correlates with the contrast on a gadolinium contrast-enhanced MRI. Objective The objective of this single-center retrospective study was to investigate if the use of fluorescein would increase the extent of resection and to examine if fluorescein guided resection influences postoperative neurological status. Methods During the study period from August 2014 to August 2018, 117 patients were operated for cerebral metastases. Of these, 56 operations were guided by fluorescein and 61 by traditional white light. All patients had an early postoperative MRI within 72 h after surgery. Results The use of fluorescein increased the extent of resection in patients with cerebral metastases. The use of fluorescein was not associated with increased postoperative sequelae or neurological damage regardless of underlying primary cancer. Conclusion Fluorescein is a helpful supplement in the neurosurgical treatment of cerebral metastases.
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-021-04796-1