Use of Sodium Fluorescein in Meningioma Surgery Performed Under the YELLOW-560 nm Surgical Microscope Filter: Feasibility and Preliminary Results

• Published in: World neurosurgery Vol. 107; pp. 966 - 973
• Main Authors: Akçakaya, Mehmet Osman, Göker, Burcu, Kasımcan, Mustafa Ömür, Hamamcıoğlu, Mustafa Kemal, Kırış, Talat
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017
• Subjects: Adult; Aged; Child, Preschool; Convexity; Feasibility Studies; Female; Fluorescein - administration & dosage; Fluorescence-guided surgery; Fluorescent Dyes - administration & dosage; Humans; Injections, Intravenous; Male; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - surgery; Meningioma; Meningioma - diagnostic imaging; Meningioma - surgery; Microsurgery - methods; Middle Aged; Neurosurgical Procedures - methods; Skull base; Sodium fluorescein; Surgical microscope; Video-Assisted Surgery - methods; Videoangiography; YELLOW 560; Young Adult; BBB; Skull base; MRI; ICG; Sodium fluorescein; Videoangiography; YELLOW 560; Fluorescence-guided surgery; Na-Fl; Surgical microscope; Convexity; Meningioma; 5-ALA
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.07.103

To evaluate the feasibility of sodium fluorescein (Na-Fl)–guided surgery involving the use of the PENTERO 900 surgical microscope equipped with the YELLOW-560 nm filter and low-dose Na-FL (200 mg/2–4 mg/kg) in meningioma surgery.
The study included 30 patients with newly diagnosed or recurrent meningiomas who underwent Na-Fl–guided surgery between April 2015 and December 2016. Clinical features, surgical observations, extent of resection, and tumor histopathology were retrospectively analyzed. The Na-Fl enhancement pattern was assessed as “no enhancement,” “diffuse homogenous enhancement,” or “low heterogeneous enhancement.”
There were 30 meningiomas among the 30 patients. In 25 patients, Na-Fl was used for tumor demarcation, whereas in 5 patients, it was used for videoangiography. In this series, 88% of tumors showed diffuse homogeneous Na-Fl enhancement during the operation. The resection rate of the meningiomas was 87%. In 5 patients, in whom Na-Fl was used for videoangiography, the approach was useful to evaluate Na-Fl-stained vessels for patency and to understand their relationship with the tumor. No adverse events were encountered with regard to Na-Fl use.
Na-Fl guidance with the use of the YELLOW-560 filter is safe and effective during meningioma surgery.