REVIEW  MINIMALLY INVASIVE AND MAXIMALLY EFFECTIVE NEUROSURGERY 

Journal of Neurosurgical Sciences 2018 December;62(6):690-703

DOI: 10.23736/S0390-5616.18.04480-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

The utilization of fluorescein in brain tumor surgery: a systematic review

Claudio CAVALLO ¹, Camilla DE LAURENTIS ², Ignazio G. VETRANO ², Jacopo FALCO ², Morgan BROGGI ², Marco SCHIARITI ², Paolo FERROLI ², Francesco ACERBI ² ✉

¹ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph Hospital and Medical Center, Phoenix, AZ, USA; ² Neurosurgical Unit II, Department of Neurosurgery, IRCCS “Istituto Neurologico C. Besta” Foundation, Milan, Italy

INTRODUCTION: Sodium fluorescein (SF) is a green, water-soluble dye with the capacity to accumulate in cerebral areas as a result of damaged blood-brain barrier (BBB); this property allows SF to concentrate specifically at the tumor site of various types of brain neoplasms, making the tumor tissue more clearly visible.
EVIDENCE ACQUISITION: A literature search (1947-2018) was conducted with the keywords “fluorescein neurosurgery,” “YELLOW neurosurgery,” “fluorescein brain tumor,” “YELLOW brain tumor.” We included clinical studies, clinical trials, observational studies, only conducted on humans and concerning surgery; in addition, we have included 3 articles derived from the analysis of the references of other papers. Ultimately, 57 articles were included for further analysis.
EVIDENCE SYNTHESIS: Fluorescein as a fluorescent tracer in neuro-oncology is gaining a wider acceptance in the neurosurgical literature: until February 1st, 2018, at least 1099 neuro-oncological patients have been operated through fluorescein-assistance, mostly only after 2012. The most important application remains the aim to improve tumor visualization and extent of resection for high-grade gliomas (HGG), but the nonspecific mechanism of action is the theoretical base for its use also for tumors different from HGG. Nevertheless, no homogenous protocol of fluorescein utilization in neurosurgical oncology can be found in literature.
CONCLUSIONS: Fluorescein-guided surgery is a safe and effective technique to improve visualization and resection of different CNS tumors and conditions, based on BBB alteration, with a growing evidence-based background.

KEY WORDS: Central nervous system neoplasms - Fluorescein - Surgery