Article
Fluorescein sodium and YELLOW 560 nm filter in paediatric neurosurgery
Natrium Fluoreszein und YELLOW 560 nm Filter in der pädiatrischen Neurochirurgie
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Published: | May 8, 2019 |
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Outline
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Objective: Surgery has a fundamental role in Central Nervous System (CNS) tumors in the pediatric population, as gross total resection (GTR) correlates with prognosis. Due to its accumulation in areas with damaged blood brain barrier, sodium fluorescein (SF) could be a valid tool to improve the extent of resection in tumors enhancing at pre-operative MRI.
Methods: Patient data were collected in two Centers, Istituto Neurologico Carlo Besta (Milan, Italy) and Regensburg Universitätsklinikum (Regensburg, Germany). At the induction of anesthesia, SF was administered intravenously (5 mg/kg). Surgery was performed using a YELLOW560 filter. Gradation of fluorescence intensity was registered as bright, moderate or absent and an opinion was given about utility of SF use (helpful, not helpful or not essential).
Results: 24 patients for 27 surgical procedures were identified. In 21/27 (77.8%) procedures fluorescence was reported as bright or moderate, in 2/27 (7.4%) absent and in 4/27 (14.8%) data were unavailable. Intraoperative fluorescence was reported in 21/25 (84%) surgeries whose corresponding pre-operative MRI had shown contrast enhancement. In 14/27 (51.8%) surgical procedures SF was considered helpful; in 2/27 (7.4%) not helpful; in 7/27 (25.9%) not essential. In 4/27 (14.8%) data were unavailable. No adverse effect to SF was registered.
Conclusion: SF could be considered a valid and safe tool to improve visualization of tumor enhancing at pre-operative MRI also in pediatric patients. Future prospective studies are needed to confirm these preliminary data.