Acta Neurochirurgica

, Volume 160, Issue 2, pp 317–324 | Cite as

Investigation of the usefulness of fluorescein sodium fluorescence in stereotactic brain biopsy

  • Ady Thien
  • Julian Xinguang Han
  • Krishan Kumar
  • Yew Poh Ng
  • Jai Prashanth Rao
  • Wai Hoe Ng
  • Nicolas Kon Kam King
Original Article - Neurosurgical Techniques



Intraoperative frozen section assessment, to confirm acquisition of pathological tissues, is used in stereotactic brain biopsy to minimise sampling errors. Limitations include the dependence on dedicated neuro-oncology pathologists and an increase in operative duration. We investigated the use of intraoperative fluorescein sodium, and compared it to frozen section assessment, for confirming pathological tissue samples in the stereotactic biopsy of gadolinium-contrast-enhancing brain lesions.


This prospective observational study consisted of 18 consecutive patients (12 men; median age, 63 years) who underwent stereotactic biopsy of gadolinium-contrast-enhancing brain lesions with intravenous fluorescein sodium administration. Twenty-three specimens were obtained and examined for the presence of fluorescence using a microscope with fluorescence visualisation capability. Positive and negative predictive values were calculated based on the fluorescence status of the biopsy samples with its corresponding intraoperative frozen section and definitive histopathological diagnosis.


Nineteen specimens (83%) were fluorescent and four (17%) were non-fluorescent. All 19 fluorescent specimens were confirmed to be lesional on intraoperative frozen section assessment and were suitable for histopathological diagnosis. Three of the non-fluorescent specimens were confirmed to be lesional on intraoperative frozen section assessment. One non-fluorescent specimen was non-diagnostic on frozen section and histological assessments. The positive predictive value was 100% and the negative predictive value was 25%.


Fluorescein sodium fluorescence is as accurate as frozen section assessment in confirming sampling of pathological tissue in the stereotactic biopsy of gadolinium-contrast-enhancing brain lesions. Fluorescein sodium fluorescence-guided stereotactic biopsy is a useful addition to the neurosurgical armamentarium.


Brain tumour Fluorescein sodium Fluorescence Stereotactic brain biopsy 



This research is supported by the Singapore Ministry of Health’s National Medical Research Council under its Translational and Clinical Research Flagship Programme—Tier 1 (Project number: NMRC/TCR/016-NNI/2016). They have no role in the design and conduct of this research.

Compliance with ethical standards

Conflict of interest

Dr King has received travel grant from Carl Zeiss Pte Ltd. The other authors have no personal financial or institutional interests in any of the devices, materials, or methods described in this article.

Ethical approval

All procedures performed 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.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2017

Authors and Affiliations

  • Ady Thien
    • 1
  • Julian Xinguang Han
    • 1
  • Krishan Kumar
    • 1
  • Yew Poh Ng
    • 1
  • Jai Prashanth Rao
    • 1
  • Wai Hoe Ng
    • 1
  • Nicolas Kon Kam King
    • 1
  1. 1.Department of NeurosurgeryNational Neuroscience InstituteSingaporeSingapore

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