gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Fluorescein Sodium and YELLOW 560 nm filter for improved visualization of brain abscesses

Meeting Abstract

  • Karl-Michael Schebesch - Klinikum der Universität Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Alexander T. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
  • Julius Höhne - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 024

doi: 10.3205/17dgnc587, urn:nbn:de:0183-17dgnc5870

Published: June 9, 2017

© 2017 Schebesch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Brain abscesses (BA) are rare intracerebral lesions. However, surgical removal or puncture of BA is frequently considered due to the space-occupying effect and/or for diminishing the cerebral infectious focus. However, meticulous identification of a premature capsule or inflammatory tissue can be challenging. As most BA are accompanied by disruption of the blood brain barrier (BBB), thus, intensely depicted by Gadolinium-enhanced magnetic resonance imaging (MRI), we sought to evaluate the efficacy of 10% Fluorescein Sodium (FL, ALCON, Germany) in combination with the YELLOW 560 nm filter of the PENTERO 900 surgical microscope (ZEISS Meditec, Germany) for improved visualization of BA in small retrospective series.

Methods: Seven consecutive patients (3 men, 4 women; mean age 53.8 years) with intracranial BA were included. In all cases, the diagnoses were confirmed microbiologically. All of the patients gave written informed consent at least on the day before craniotomy as the administration of FL in neurosurgery still is off-label. 5 mg/kg bodyweight of FL were injected during induction of anesthesia via the central venous line. In all cases, the PENTERO 900 surgical microscope, equipped with the YELLOW 560 nm filter was used while approaching the lesion and during removal of the capsule and the pus.

Results: In all cases brilliant visualization and intense fluorescence of the BA capsules were achieved under the filtered light. However, the pus was never enhanced by FL. We encountered no adverse events or allergic reactions due to the administration of FL.

Conclusion: To the best of our knowledge, this is the first report about the use of fluorescence-guided resection of BA. Under the dedicated YELLOW 560 nm filter, FL broadly visualizes BA. This can be helpful in approaching and resecting contrast-enhancing inflammatory cerebral lesions.