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Journal of Neurosurgical Sciences 2019 December;63(6):679-87

DOI: 10.23736/S0390-5616.19.04601-0


lingua: Inglese

The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study

Camilla de LAURENTIS 1, Julius HÖHNE 2, Claudio CAVALLO 1, 3, Francesco RESTELLI 1, Jacopo FALCO 1, Morgan BROGGI 1, Lorenzo BOSIO 1, Ignazio G. VETRANO 1, Marco SCHIARITI 1, Costanza M. ZATTRA 1, Paolo FERROLI 1, Karl-Michael SCHEBESCH 1, Francesco ACERBI 1

1 Department of Neurosurgery, Carlo Besta Institute of Neurology, IRCCS and Foundation, Milan, Italy; 2 Department of Neuropathology and Neurosurgery, Regensburg University Hospital, Regensburg, Germany; 3 Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

BACKGROUND: Surgery has a fundamental role in central nervous system (CNS) tumors in the pediatric population, as aggressive resection correlates with prognosis. Due to its accumulation in areas with damaged blood brain barrier, sodium fluorescein (SF) could be a valid tool to improve the extent of resection in tumors enhancing at preoperative MRI. This study is aimed to systematically assess the utility of SF in a pediatric population.
METHODS: Patient data were collected in two centers, one in Italy and the other in Germany. At the induction of anesthesia, SF was administered intravenously (5 mg/kg). Surgery was performed using a YELLOW560 filter. Fluorescence intensity was graduated as bright, moderate or absent based on surgeon’s opinion; furthermore, SF use was judged as “helpful,” “not helpful” or “not essential” in tumor removal.
RESULTS: Twenty-four patients for 27 surgical procedures were identified. In 21 of 27 (77.8%) procedures fluorescence was reported as bright or moderate, in two of 27 (7.4%) absent and in four of 27 (14.8%) data were unavailable. Intraoperative fluorescence was reported in 21 of 25 (84%) surgeries whose corresponding preoperative MRI had shown contrast enhancement. In 14 of 27 (51.8%) surgical procedures SF was considered “helpful”; in two of 27 (7.4%) not “helpful”; in seven of 27 (25.9%) “not essential.” In four of 27 (14.8%) data were unavailable. No adverse effect to SF was registered.
CONCLUSIONS: SF could be considered a valid and safe tool to improve visualization of tumors enhancing at preoperative MRI also in pediatric patients. Future prospective studies are needed to confirm these preliminary data.

KEY WORDS: Fluorescein; Neurosurgery; Pediatrics; Video-assisted surgery

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