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Fluorescein-guided resection of cerebral metastases is associated with greater tumor resection

  • Original Article - Tumor - Other
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Sodium fluorescein (fluorescein) crosses a disrupted blood-brain barrier similarly to gadolinium contrast in contrast-enhancing cerebral tumors. When exposed to light with 560 nm wavelength during surgery, fluorescein emits a yellow-green fluorescent light that can be visualized through an operating microscope equipped with an appropriate emission filter. The distribution of the fluorescence correlates with the contrast on a gadolinium contrast-enhanced MRI.

Objective

The objective of this single-center retrospective study was to investigate if the use of fluorescein would increase the extent of resection and to examine if fluorescein guided resection influences postoperative neurological status.

Methods

During the study period from August 2014 to August 2018, 117 patients were operated for cerebral metastases. Of these, 56 operations were guided by fluorescein and 61 by traditional white light. All patients had an early postoperative MRI within 72 h after surgery.

Results

The use of fluorescein increased the extent of resection in patients with cerebral metastases. The use of fluorescein was not associated with increased postoperative sequelae or neurological damage regardless of underlying primary cancer.

Conclusion

Fluorescein is a helpful supplement in the neurosurgical treatment of cerebral metastases.

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Abbreviations

MRI:

Magnetic resonance imaging

RANO:

Response assessment in neuro-oncology

EOR:

Extent of resection

ICD 10:

International Statistical Classification of Diseases and Related Health Problems, 10th Revision

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Acknowledgements

The assistance of Claire Gudex (BRIDGE) in the editing of this manuscript is greatly appreciated. The guidance of Pia Veldt Larsen on the biostatistics of this study.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Odense University Hospital, Odense, Denmark

    Mikkel S. Kofoed, Christian B. Pedersen, Mette K. Schulz, Rasmus W. Hansen, Bo Halle & Frantz R. Poulsen

  2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Mikkel S. Kofoed, Christian B. Pedersen, Mette K. Schulz, Bjarne W. Kristensen, Rasmus W. Hansen, Bo Halle & Frantz R. Poulsen

  3. BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Odense, Denmark

    Mikkel S. Kofoed, Christian B. Pedersen, Mette K. Schulz, Bjarne W. Kristensen, Bo Halle & Frantz R. Poulsen

  4. Department of Pathology, Odense University Hospital, Odense, Denmark

    Bjarne W. Kristensen

  5. Department of Radiology, Odense University Hospital, Odense, Denmark

    Ljubo Markovic

Authors
  1. Mikkel S. Kofoed
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  2. Christian B. Pedersen
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  3. Mette K. Schulz
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  4. Bjarne W. Kristensen
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  5. Rasmus W. Hansen
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  6. Ljubo Markovic
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  7. Bo Halle
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  8. Frantz R. Poulsen
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Corresponding author

Correspondence to Mikkel S. Kofoed.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Odense University Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required

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The authors declare no competing interests.

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Kofoed, M.S., Pedersen, C.B., Schulz, M.K. et al. Fluorescein-guided resection of cerebral metastases is associated with greater tumor resection. Acta Neurochir 164, 451–457 (2022). https://doi.org/10.1007/s00701-021-04796-1

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  • DOI: https://doi.org/10.1007/s00701-021-04796-1

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