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Fluorescein sodium-guided resection of cerebral metastases—an update

  • Original Article - Brain Tumors
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Abstract

Background

Cerebral metastasis (CM) is the most common malignancy affecting the brain. In patients eligible for surgery, complete tumor removal is the most important predictor of overall survival and neurological outcome. The emergence of surgical microscopes fitted with a fluorescein-specific filter have facilitated fluorescein-guided microsurgery and identification of tumor tissue. In 2012, we started evaluating fluorescein (FL) with the dedicated microscope filter in cerebral metastases (CM). After describing the treatment results of our first 30 patients, we now retrospectively report on 95 patients.

Methods

Ninety-five patients with CM of different primary cancers were included (47 women, 48 men, mean age, 60 years, range, 25–85 years); 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560-nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control.

The extent of resection (EOR) was assessed by means of early postoperative contrast-enhanced MRI and the grade of fluorescent staining as described in the surgical reports. Furthermore, we evaluated information on neurological outcome and surgical complications as well as any adverse events.

Results

Ninety patients (95%) showed bright fluorescent staining that markedly enhanced tumor visibility. Five patients (5%); three with adenocarcinoma of the lung, one with melanoma of the skin, and one with renal cell carcinoma) showed insufficient FL staining. Thirteen patients (14%) showed residual tumor tissue on the postoperative MRI. Additionally, the MRI of three patients did not confirm complete resection beyond doubt. Thus, gross-total resection had been achieved in 83% (n = 79) of patients. No adverse events were registered during the postoperative course.

Conclusions

FL and the YELLOW 560-nm filter are safe and feasible tools for increasing the EOR in patients with CM. Further prospective evaluation of the FL-guided technique in CM-surgery is in planning.

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany

    Julius Höhne, Christoph Hohenberger, Martin Proescholdt, Alexander Brawanski & Karl-Michael Schebesch

  2. Institute of Radiology, Neuroradiology Branch, University Medical Center Regensburg, Regensburg, Germany

    Christina Wendl

  3. Institute of Neuropathology, University Medical Center Regensburg, Regensburg, Germany

    Markus J Riemenschneider

  4. Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany

    Julius Höhne, Christoph Hohenberger, Martin Proescholdt, Markus J Riemenschneider, Christina Wendl, Alexander Brawanski & Karl-Michael Schebesch

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  1. Julius Höhne
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  2. Christoph Hohenberger
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  4. Markus J Riemenschneider
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  6. Alexander Brawanski
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Correspondence to Julius Höhne.

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Funding

No funding was received for this research.

Conflict of interest

Alexander Brawanski and Karl-Michael Schebesch have received speaker’s fees from Carl Zeiss Meditec, Oberkochen, Germany. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures conducted in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Höhne, J., Hohenberger, C., Proescholdt, M. et al. Fluorescein sodium-guided resection of cerebral metastases—an update. Acta Neurochir 159, 363–367 (2017). https://doi.org/10.1007/s00701-016-3054-3

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  • DOI: https://doi.org/10.1007/s00701-016-3054-3

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