Article
Fluorescein Sodium and YELLOW 560 nm filter application for enhanced visualization of the facial nerve in parotid gland surgery
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Authors
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Karl-Michael Schebesch
- Klinik für Neurochirurgie am Universitätsklinikum Regensburg, Germany
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Julius Höhne
- Klinik für Neurochirurgie am Universitätsklinikum Regensburg, Germany
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Holger Gassner
- Klinik für HNO-Heilkunde am Universitätsklinikum Regensburg, Germany
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Alexander Brawanski
- Klinik für Neurochirurgie am Universitätsklinikum Regensburg, Germany
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Frank Haubner
- Klinik für HNO-Heilkunde am Universitätsklinikum Regensburg, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Preservation of the facial nerve (N.VII) is a keystone in parotid gland surgery. A technical adjunct that potentially enhances the contrast between N.VII and the adherent tumor tissue could be Fluorescein Sodium (FL, 10%, ALCON, Germany) and application of the YELLOW 560 nm filter (YE, Carl Zeiss Meditec, Oberkochen). Here, we present the preliminary data concerning feasibility and safety of FL/YE in patients with parotid gland adenoma.
Method: In 7 patients (3 male, 4 female; mean age 53.5 years, range 18 to 78 years) with parotid gland adenomas FL/YE was applied in terms of an off-label use. The tumor removal was conducted microsurgically by the ENT team and a neurosurgeon. 5mg/kg bodyweight of FL was applied intravenously at induction of anesthesia. We evaluated the contrast of N.VII with respect to surrounding tumor, gland and vasculature. The ENT surgeon’s objection was rated as ‘contrast-enhancing’ and ‘not contrast-enhancing’.
Results: In all patients, the procedure was mainly conducted under the YE filter. N.VII, adenoma and parotid gland showed different fluorescence and the rating ‘contrast-enhancing’ was assigned in all cases. Complete tumor removal was achieved in all patients. One patient had a moderate, transient facial palsy. We encountered no adverse events or allergic reactions.
Conclusions: This is the first clinical study concerning the application of FL/YE in parotid gland surgery and we could show that FL/YE is feasible, beneficial and safe for N.VII protection and improved tumor removal. In many other ENT tumors (e.g. parotid carcinomas), visualization of the facial nerve is crucial for the surgical outcome. Thus, FL/YE could become a beneficial surgical tool in head and neck surgery and prospective clinical trials are well justified.
