Fluorescein-guided surgery for spinal gliomas: Analysis of 220 consecutive cases.

Zhenxing Sun, Linkai Jing, Yingwei Fan, Huifang Zhang, Lin Chen, Guihuai Wang, Hari Shanker Sharma, James Wang

Journal: International review of neurobiology 2021;151():139-154

PMID: 32448604

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

Sodium fluorescein (FL) is widely used as a fluorescent tracer for brain tumor resection. However, FL-guided resection of spinal gliomas has been reported only occasionally. To evaluate the safety, characteristics, and usefulness of FL-guided surgery in the resection of spinal glioma.

METHODS

Between January 2015 and December 2018, 220 consecutive patients with 227 spinal gliomas underwent FL-guided resection using the Zeiss Pentero 900 surgical microscope with an integrated YELLOW 560 filter. FL evaluation and clinical outcomes were analyzed.

RESULTS

No FL-related complications occurred in this series. Entire tumor fluorescence was observed in 161 (70.93%) gliomas, nodular fluorescence in 46 (20.26%) tumors, and no fluorescence in 20 (8.81%) tumors. The intraoperative fluorescence of 217 (95.59%) gliomas was highly correlated with preoperative contrast-enhancing magnetic resonance imaging, except in eight ependymomas, one pilocytic astrocytoma, and one diffuse midline glioma. Gross-total resection was achieved in 78.85% (179/227) of spinal gliomas, including 94.30% (149/158) ependymal tumors and 43.48% (30/69) astrocytic and oligodendroglial tumors. At the final clinical follow-up, the spinal function of 75 (33.04%) patients showed significant improvement, 105 (46.26%) showed stabilization, and 47 (20.70%) showed deterioration.

CONCLUSION

FL is a safe and useful real-time tool that could enhance tumor borders or residual tumors and hence increase the gross-total resection rate in cases with contrast-enhanced tumors.

Address: Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.; Beijing Institute of Radiation Medicine, Beijing, China.; Department of Neurosurgery, Tsinghua University Yuquan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.; International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, University Hospital, Uppsala University, S-75185 Uppsala, Sweden. Electronic address: [email protected].; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China. Electronic address: [email protected].

DOI: 10.1016/bs.irn.2020.03.004

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MeSH Terms: Adult, Female, Fluorescein, Fluorescent Dyes, Glioma, Humans, Magnetic Resonance Imaging, Male, Microscopy, Microsurgery, Middle Aged, Neurosurgical Procedures, Outcome and Process Assessment, Health Care, Spinal Cord Neoplasms, Surgery, Computer-Assisted