Skip to main content
SpringerLink
Log in

Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module

  • Clinical Article - Neurosurgical Techniques
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Fluorescent technology has recently become a valuable tool in the surgical management of neoplastic and vascular lesions. The availability of microscope-integrated fluorescent modules has facilitated incorporation of this technology within the microsurgical workflow. The currently available microscope integrated modules use 5-aminolevulinic acid (5-ALA) and indocyanine green (ICG) as fluorophores.

Methods

Fluorescein sodium is a fluorescent molecule that has been used specifically in ophthalmology for the treatment of retinal angiography. A new microscope-integrated fluorescent module has been recently developed for fluorescein. We employed this technology to maximize resection of tumors and perform intraoperative angiography to guide microsurgical management of aneurysms and arteriovenous malformations.

Results

Fluorescein fluorescence allows the surgeon to appreciate fluorescent structures through the oculars while visualizing non-fluorescent tissues in near natural colors. Therefore, the operator can proceed with microsurgery under the fluorescent mode. We present three representative cases in which the use of fluorescein fluorescence was found useful in the surgeon’s decision making during surgery.

Conclusions

The applications of this new microscope-integrated fluorescent module are multiple, and include vascular and oncologic neurosurgery. Further clinical investigations with large patient cohorts are needed to fully establish the role of this new technology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dashti R, Laakso A, Niemelä M, Porras M, Hernesniemi J (2009) Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience. Surg Neurol 71:543–550, discussion 550

    Article  PubMed  Google Scholar 

  2. Dilek O, Ihsan A, Tulay H (2011) Anaphylactic reaction after fluorescein sodium administration during intracranial surgery. J Clin Neurosci 18:430–431

    Article  PubMed  Google Scholar 

  3. Feindel W, Yamamoto YL, Hodge CP (1971) Red cerebral veins and the cerebral steal syndrome. Evidence from fluorescein angiography and microregional blood flow by radioisotopes during excision of an angioma. J Neurosurg 35:167–179

    Article  PubMed  CAS  Google Scholar 

  4. Karhunen U, Raitta C, Kala R (1986) Adverse reactions to fluorescein angiography. Acta Ophthalmol (Copenh) 64:282–286

    Article  CAS  Google Scholar 

  5. Keerl R, Weber RK, Draf W, Wienke A, Schaefer SD (2004) Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope 114:266–272

    Article  PubMed  CAS  Google Scholar 

  6. Koc K, Anik I, Cabuk B, Ceylan S (2008) Fluorescein sodium-guided surgery in glioblastoma multiforme: a prospective evaluation. Br J Neurosurg 22:99–103

    Article  PubMed  CAS  Google Scholar 

  7. Kwan ASL, Barry C, McAllister IL, Constable I (2006) Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience. Clin Experiment Ophthalmol 34:33–38

    Article  PubMed  Google Scholar 

  8. Kwiterovich KA, Maguire MG, Murphy RP, Schachat AP, Bressler NM, Bressler SB, Fine SL (1991) Frequency of adverse systemic reactions after fluorescein angiography. Results of a prospective study. Ophthalmology 98:1139–1142

    PubMed  CAS  Google Scholar 

  9. Little JR, Yamamoto YL, Feindel W, Meyer E, Hodge CP (1979) Superficial temporal artery to middle cerebral artery anastomosis. Intraoperative evaluation by fluorescein angiography and xenon-133 clearance. J Neurosurg 50:560–569

    Article  PubMed  CAS  Google Scholar 

  10. Moore GE, Peyton WT (1948) The clinical use of fluorescein in neurosurgery; the localization of brain tumors. J Neurosurg 5:392–398

    Article  PubMed  CAS  Google Scholar 

  11. Moosbrugger KA, Sheidow TG (2008) Evaluation of the side effects and image quality during fluorescein angiography comparing 2 mL and 5 mL sodium fluorescein. Can J Ophthalmol 43:571–575

    Article  PubMed  Google Scholar 

  12. Murray KJ (1982) Improved surgical resection of human brain tumors: Part I. A preliminary study. Surg Neurol 17:316–319

    Article  PubMed  CAS  Google Scholar 

  13. Okuda T, Kataoka K, Yabuuchi T, Yugami H, Kato A (2010) Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium. J Clin Neurosci 17:118–121

    Article  PubMed  Google Scholar 

  14. Pacurariu RI (1982) Low incidence of side effects following intravenous fluorescein angiography. Ann Ophthalmol 14:32–36

    PubMed  CAS  Google Scholar 

  15. Placantonakis DG, Tabaee A, Anand VK, Hiltzik D, Schwartz TH (2007) Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery 61:161–165, discussion 165–166

    Article  PubMed  Google Scholar 

  16. Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FPK, Kamerman JD, Seifert V, Spetzler RF (2005) Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg 103:982–989

    Article  PubMed  Google Scholar 

  17. Shinoda J, Yano H, Yoshimura S-I, Okumura A, Kaku Y, Iwama T, Sakai N (2003) Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note. J Neurosurg 99:597–603

    Article  PubMed  Google Scholar 

  18. Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ (2000) Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg 93:1003–1013

    Article  PubMed  CAS  Google Scholar 

  19. Stummer W, Stepp H, Möller G, Ehrhardt A, Leonhard M, Reulen HJ (1998) Technical principles for protoporphyrin-IX-fluorescence guided microsurgical resection of malignant glioma tissue. Acta Neurochir (Wein) 140:995–1000

    Article  CAS  Google Scholar 

  20. Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, ALA-Glioma Study Group (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401

    Article  PubMed  CAS  Google Scholar 

  21. Tanahashi S, Lida H, Dohi S (2006) An anaphylactoid reaction after administration of fluorescein sodium during neurosurgery. Anesth Analg 103:503

    Article  PubMed  Google Scholar 

  22. Uzuka T, Takahashi H, Fuji Y (2007) Surgical strategy for malignant glioma resection with intraoperative use of fluorescein Na. No Shinkei Geka 35:557–562

    PubMed  Google Scholar 

  23. Wrobel CJ, Meltzer H, Lamond R, Alksne JF (1994) Intraoperative assessment of aneurysm clip placement by intravenous fluorescein angiography. Neurosurgery 35:970–973, discussion 973

    Article  PubMed  CAS  Google Scholar 

  24. Yannuzzi LA, Rohrer KT, Tindel LJ, Sobel RS, Costanza MA, Shields W, Zang E (1986) Fluorescein angiography complication survey. Ophthalmology 93:611–617

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Roland Guckler for his assistance with technical information in this article.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA

    Roberto Rey-Dios

  2. Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN, 46202, USA

    Aaron A. Cohen-Gadol

Authors
  1. Roberto Rey-Dios
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron A. Cohen-Gadol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aaron A. Cohen-Gadol.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rey-Dios, R., Cohen-Gadol, A.A. Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. Acta Neurochir 155, 701–706 (2013). https://doi.org/10.1007/s00701-013-1635-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1635-y

Keywords

Search

Navigation