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Extracapsular dissection in peripheral nerve schwannoma surgery using bright light and fluorescein sodium visualization: case series

  • Michel Kalamarides
  • Isabelle Bernat
  • Matthieu PeyreEmail author
Original Article - Peripheral Nerves
  • 35 Downloads
Part of the following topical collections:
  1. Peripheral Nerves

Abstract

Background

Schwannomas are the most frequent peripheral nerve sheath tumors and are treated by surgical resection when symptomatic. Tumor removal is performed by intraneural dissection and enucleation. In order to safely remove the tumor from the nerve, the use of sodium fluorescein has recently been proposed to distinguish the tumor from the adjacent normal nerve fibers, before incision of the tumor pseudocapsule and during intraneural tumor dissection.

Methods

We report a consecutive case series of 5 peripheral nerve schwannomas operated in 4 patients, in which we evaluate the usefulness of sodium fluorescein compared to usual visual landmarks, at each step of the surgical procedure.

Results

After exposition of the schwannoma, sodium fluorescein helped with the localization of intracapsular en passant nerve fascicles in only one case. Hence, the definition of a safe entry zone for capsular incision relied mainly on nerve monitoring and direct visualization of en passant nerve fascicles under microscope. During intraneural dissection, there was a sharp contrast between the fluorescent tumor and the non-fluorescent adjacent pseudocapsule in most cases but the colorimetric variation between tumor and normal tissue induced by fluorescence did not outperform the natural contrast between the yellow true capsule and the gray-red layers of the pseudocapsule.

Conclusion

Based on these results, we consider that the limited additional value of sodium fluorescein in primary peripheral nerve schwannoma surgery does not warrant its use in daily clinical practice. Additional studies are needed to assess its usefulness during the surgery of recurrences and tumors which are intertwined with several fascicles of origin such as neurofibromas.

Keywords

Peripheral nerve sheath tumors Schwannoma Sodium fluorescein NF2 

Notes

Acknowledgments

We would like to thank Mr. Pinto at Zeiss France for the 2-month trial of the YELLOW 560 filter.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Pitié-Salpêtrière research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Patient consent

All four patients have consented to the submission of the case reports to the journal.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sorbonne Universités-Department of Neurosurgery, Batiment BabinskiGroupe Hospitalier Pitié-Salpêtrière, APHPParisFrance
  2. 2.Neurofibromatosis Type 2 and Schwannomatosis National Reference CenterGroupe Hospitalier Pitié-Salpêtrière, APHPParisFrance
  3. 3.Sorbonne Universités-Department of NeurophysiologyGroupe Hospitalier Pitié-Salpêtrière, APHPParisFrance

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