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Journal of Neurosurgical Sciences 2018 Jul 17

DOI: 10.23736/S0390-5616.18.04494-6


language: English

Fluorescent tracers in neurosurgical procedures: an European survey

Francesco ACERBI 1 , Francesco RESTELLI 1, Camilla DE LAURENTIS 1, Jacopo FALCO 1, Claudio CAVALLO 1, Morgan BROGGI 1, Julius HÖHNE 2, Karl-Michael SCHEBESCH 2, Marco SCHIARITI 1, Paolo FERROLI 1

1 Department of Neurosurgery, Foundation IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; 2 Department of Neuropathology and Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany


BACKGROUND: In recent years several techniques have been proposed with the aim of improving tumors visualization and extent of resection and, among them, the use of photosensitive dyes is gaining great interest. Regarding the application of the two most used dyes, 5-aminolevulinic acid (5-ALA) and sodium fluorescein (SF), there is still a lack of shared and established protocols among different centers. The main objective of the present study was to evaluate the current practice of fluorescence-guided techniques in neuro-oncological surgery in Europe.
METHODS: An online questionnaire consisting of 33 questions was completed by 136 European Association of Neurosurgical Societies neurosurgeons. Responses were entered into a database and subsequently analyzed.
RESULTS: Data were analyzed from 136 out of 1476 active European neurosurgeons which had been contacted, with a 9,2% response rate. Based on the data from the questionnaire, Germany was the most responsive country (15% of the total respondents) and the main indication for 5-ALA and SF utilization were high-grade gliomas. 5-ALA was mainly used as defined in Gliolan® datasheet, while SF as off-label technique with a 5 mg/kg dose of injection at the end of patient intubation. Both the dyes were mainly used in adult population, more frequently by neurosurgeons with less-than 20 cases per year expertise. Mean price per patient were 817,6 € and 7,7 € for 5-ALA and SF, respectively.
CONCLUSIONS: 5-ALA acid is still the preferred and more established fluorescent dye used during high-grade gliomas resection, with SF as a gaining-attention, really cheaper and more ductile alternative.

KEY WORDS: Fluorescent tracers - 5-ALA - Fluorescein - Glioma - Survey

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