Article
Fluorescein sodium-guided resection of cerebral metastases – experience with first 74 patients
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Authors
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Julius Hoehne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
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Markus J. Riemenschneider
- Institute of Neuropathology, University Medical Center Regensburg, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
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Christina Wendl
- Institute of Radiology, Neuroradiology Branch, University Medical Center Regensburg, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
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Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
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Karl-Michael Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Cerebral metastasis (CM) is the most common malignancy affecting the brain. Improved multimodal therapeutic options are required to strengthen the role of surgical treatment, which is already proven to be effective regarding survival and local recurrence. Recently, the emergence of surgical microscopes with fluoresceinspecific filters has facilitated fluorescein-guided microsurgery and identification of tumor tissue. We present our experience with Fluorescein Sodium (FL) and the dedicated surgical microscope filter YELLOW 560 nm (Pentero 900, ZEISS Meditec, Germany) in 74 patients with CM.
Method: 74 patients with CM of different primary cancers were included (35 women, 39 men, mean age 59 years). 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560 nm filter was used for microsurgical tumor resection and resection control. Surgical reports were evaluated regarding the degree of fluorescent staining, postoperative MRIs within 48 hours regarding the extent of resection (Gadolinium-enhanced T1-weighted sequence) and postoperative courses regarding any adverse effects and neurological performance.
Results: Most patients (93%, n=69) showed bright fluorescent staining, which enhanced tumor visibility. 5 patients (8%; 3 with adenocarcinoma of the lung, 1 with cutaneous melanoma and 1 with renal-cell carcinoma) showed no or only insufficient FL staining. In 11 patients (15%) residual tumor tissue was detected on MRI. In four other patients, radiographic examination could not exclude very small areas of residual tumor tissue, these patients were added to the ‘residual tumor’ group. Thus, gross-total resection was achieved in 82,4% (n=61) of patients. No adverse effects were registered over the postoperative course.
Conclusions: FL and the YELLOW 560 nm filter are readily available and feasible tools for safe increase in resection of CM. To further evaluate the effects of this technique we aim to conduct the FLUCEM trial (FLUorescein Sodium in CErebral Metastases), a randomized, controlled, multicenter, open-label trial of fluorescein sodium-guided resection of cerebral metastases versus standard resection.
