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Fluorescein-guided resection of a left frontal pre-rolandic cerebral metastasis: how I do it

  • How I Do it
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Abstract

Background

Cerebral metastases (CM) are the most common intracranial tumors; several studies have underlined the fundamental role of neurosurgical lesion removal.

Method

We describe the surgical resection of a left frontal single metastasis. We attempted to achieve a radical resection under the intraoperative guidance of fluorescein, with the aid of intraoperative neurological monitoring. This technique can be applied to each contrast enhancing, intra-axial, infiltrative lesion.

Conclusion

Fluorescein-guided surgery is a valuable tool in CM surgery to increase the rate of resection; further prospective evaluation of the role of fluorescein in this field is in planning, aiming to study the prognostic impact.

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Data availability

The data presented in this study are available on request from the authors.

Abbreviations

BBB:

Blood-brain barrier

CM:

Cerebral metastases

CUSA:

Cavitron ultrasound aspirator

SF:

Sodium fluorescein

TcMEP:

Transcranial motor evoked potentials

References

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Acknowledgements

The authors thank all the neurophysiologists and technicians for their valuable work during eloquent tumor removal and, in particular, Paola Lanteri and Valentina Catanzaro for their contribution in this specific case and during manuscript production.

Funding

This study was partially supported by the Associazione Paolo Zorzi per le Neuroscienze, ONLUS and by the Italian Ministry of Health (RRC).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy

    Francesco Acerbi, Morgan Broggi, Paolo Ferroli & Jacopo Falco

Authors
  1. Francesco Acerbi
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  2. Morgan Broggi
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  3. Paolo Ferroli
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  4. Jacopo Falco
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Corresponding author

Correspondence to Francesco Acerbi.

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Conflict of interest

Dr. Francesco Acerbi received honoraria from Carl Zeiss Meditec for lectures in International Meetings.

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Key Points

(1) Select for neurosurgery the correct patient after a multidisciplinary discussion with a shared therapeutic rationale.

(2) Strong collaboration with neurophysiologists during surgical procedure.

(3) Fluorescein injection at the standardized low dose of 5 mg/kg, immediately upon completion of general anesthesia; take care to discuss with the patient regarding the advantages of this dye and the related low risks.

(4) Use neuronavigation to tailor surgical approach and craniotomy.

(5) Start from enucleation and en-bloc removal of the lesion.

(6) Prosecute by aspirating the infiltrative micro-metastases, detectable with YELLOW560 filter activated.

(7) Indocyanine green video-angiography could be safely performed to study major vessels: both dyes are compatible.

(8) Perform hemostasis under white-light illumination after arterial pressure challenge.

(9) Finally check resection borders comparing white light and YELLOW560 visualization.

(10) An early postoperative MRI is mandatory, and an oncological follow-up is necessary to guarantee the adequate path of care.

Supplementary Information

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Supplementary file1 (MP4 90705 KB)

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Acerbi, F., Broggi, M., Ferroli, P. et al. Fluorescein-guided resection of a left frontal pre-rolandic cerebral metastasis: how I do it. Acta Neurochir 165, 2519–2524 (2023). https://doi.org/10.1007/s00701-023-05635-1

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  • DOI: https://doi.org/10.1007/s00701-023-05635-1

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