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Application of sodium fluorescein for spinal cord lesions: intraoperative localization for tissue biopsy and surgical resection

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Abstract

Sodium fluorescein (NaFL) has been used to aid in the resection of primary and secondary lesions within the brain. Comparatively, there is limited research on clinical applications for lesions within the spinal cord. Fluorescein-guided microsurgery may increase the ability to localize and safely surgically treat spinal lesions. Twelve patients with spinal cord lesions received fluorescein sodium 10% (Alcon Laboratories INC, Fort Worth, TX, USA) at 3 mg/kg prior to surgical resection. Intraoperative visualization of fluorescence was performed using a Zeiss Pentero (Carl Zeiss AG, Oberkochen, Germany) microscope equipped with a Yellow560 filter or a Leica OH6 (Leica Microsystems, Wetzlar, Germany) equipped with a FL560 filter. Administration of NaFL resulted in lesional fluorescent contrast extravasation and facilitated surgical resection and localization in all twelve patients. In patients with a goal of complete resection, NaFL aided in complete resection of the spinal lesions in seven patients. In surgical resection patients, pathology was consistent with WHO grade I myxopapillary ependymoma in one patient, WHO grade II ependymoma in five patients, and nerve sheath tumor in one patient. In the other five patients, NaFL allowed for intraoperative tissue identification and successful tissue biopsy. In patients undergoing biopsy, tissue samples were positive for an intramedullary abscess, EBV-driven lymphoproliferative disease, and primary glial neoplasms. Fluorescein is a helpful microsurgical tool in guiding surgical resection and in the localization of intramedullary spinal lesions. Further research is necessary to explore fluorescein sodium applications in the resection of spinal cord lesions.

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Data availability

The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author upon request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Colorado School of Medicine, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA

    Timothy H. Ung, Stephanie Serva, Grégoire P. Chatain, Jens-Peter Witt & Michael Finn

  2. The Spine Center at University of Colorado Hospital, Aurora, CO, 80045, USA

    Jens-Peter Witt & Michael Finn

Authors
  1. Timothy H. Ung
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  2. Stephanie Serva
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  3. Grégoire P. Chatain
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  4. Jens-Peter Witt
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  5. Michael Finn
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Contributions

All named authors contributed to the chart review, data acquisition and analysis for this study. All authors contributed to drafting and critically revising the work and granted final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Timothy H. Ung.

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Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of University of Colorado approved this study.

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This retrospective chart review study did not require patient consent to participate.

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This retrospective chart review study did not require patient consent for publication. All authors listed consent for publication.

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The authors declare no competing interests.

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Jens-Peter Witt and Michael Finn share senior authorship.

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Ung, T.H., Serva, S., Chatain, G.P. et al. Application of sodium fluorescein for spinal cord lesions: intraoperative localization for tissue biopsy and surgical resection. Neurosurg Rev 45, 1563–1569 (2022). https://doi.org/10.1007/s10143-021-01676-1

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  • DOI: https://doi.org/10.1007/s10143-021-01676-1

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