Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors

Results from a Preliminary, Multicentric, Retrospective Study

Francesco Acerbi, Claudio Cavallo, Karl Michael Schebesch, Mehmet Osman Akçakaya, Camilla de Laurentis, Mustafa Kemal Hamamcioglu, Morgan Broggi, Alexander Brawanski, Jacopo Falco, Roberto Cordella, Paolo Ferroli, Talat Kiris, Julius Höhne

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background Intramedullary spinal cord tumors (IMSCTs) are rare, heterogenous lesions that are usually enhanced on preoperative magnetic resonance imaging (MRI) because of a damaged blood-brain barrier. Sodium fluorescein is a dye that accumulates in areas of the central nervous system with a damaged BBB. Given the pattern of MRI contrast enhancement of the majority of IMSCTs, the use of this fluorescent tracer could improve tumor visualization and quality of resection. In this article, we present the first experience with the application of fluorescein-guided technique for surgical removal of IMSCTs. Methods Eleven patients (6 men, 5 women; mean age, 50.1 years), harboring 5 ependymomas, 3 hemangioblastomas, 1 astrocytoma, 1 pilocytic astrocytoma, and 1 glioneuronal tumor forming rosettes were included. Sodium fluorescein (5 mg/kg) was injected immediately after patient intubation. Tumors were removed with microsurgical technique and standard neurophysiological monitoring, under YELLOW 560 filter (Pentero 900) visualization. Surgical reports were reviewed regarding usefulness and grade of fluorescein staining. Postoperative MRI was performed within 72 hours after surgery, and postoperative clinical outcome was registered. Results No adverse events were registered. Fluorescent staining was reported in 9 of 11 cases (82%), all of them enhancing on preoperative MRI (100% of ependymomas, 100% of pilocytic astrocytomas, 100% of hemangioblastomas). No fluorescence was reported in 1 astrocytoma and 1 glioneuronal tumor–forming rosette. Intraoperative fluorescence was considered helpful for tumor resection in 9 of 11 cases (82%). Gross total resection was obtained in 8 of 11 cases (72.7%). Conclusions Our results suggest that fluorescein-guided surgery is a safe and effective technique that can be used during the surgical resection of IMSCTs presenting with contrast-enhancement on preoperative MRI.

Original languageEnglish
Pages (from-to)603-609
Number of pages7
JournalWorld Neurosurgery
Volume108
DOIs
Publication statusPublished - Dec 1 2017

Fingerprint

Spinal Cord Neoplasms
Fluorescein
Astrocytoma
Retrospective Studies
Magnetic Resonance Imaging
Hemangioblastoma
Ependymoma
Neoplasms
Neurophysiological Monitoring
Fluorescence
Staining and Labeling
Blood-Brain Barrier
Intubation
Coloring Agents
Central Nervous System

Keywords

  • Intramedullary spinal cord tumor
  • Resection
  • Sodium fluorescein
  • YELLOW 560 filter

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors : Results from a Preliminary, Multicentric, Retrospective Study. / Acerbi, Francesco; Cavallo, Claudio; Schebesch, Karl Michael; Akçakaya, Mehmet Osman; de Laurentis, Camilla; Hamamcioglu, Mustafa Kemal; Broggi, Morgan; Brawanski, Alexander; Falco, Jacopo; Cordella, Roberto; Ferroli, Paolo; Kiris, Talat; Höhne, Julius.

In: World Neurosurgery, Vol. 108, 01.12.2017, p. 603-609.

Research output: Contribution to journalArticle

Acerbi, F, Cavallo, C, Schebesch, KM, Akçakaya, MO, de Laurentis, C, Hamamcioglu, MK, Broggi, M, Brawanski, A, Falco, J, Cordella, R, Ferroli, P, Kiris, T & Höhne, J 2017, 'Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors: Results from a Preliminary, Multicentric, Retrospective Study', World Neurosurgery, vol. 108, pp. 603-609. https://doi.org/10.1016/j.wneu.2017.09.061
Acerbi, Francesco ; Cavallo, Claudio ; Schebesch, Karl Michael ; Akçakaya, Mehmet Osman ; de Laurentis, Camilla ; Hamamcioglu, Mustafa Kemal ; Broggi, Morgan ; Brawanski, Alexander ; Falco, Jacopo ; Cordella, Roberto ; Ferroli, Paolo ; Kiris, Talat ; Höhne, Julius. / Fluorescein-Guided Resection of Intramedullary Spinal Cord Tumors : Results from a Preliminary, Multicentric, Retrospective Study. In: World Neurosurgery. 2017 ; Vol. 108. pp. 603-609.
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abstract = "Background Intramedullary spinal cord tumors (IMSCTs) are rare, heterogenous lesions that are usually enhanced on preoperative magnetic resonance imaging (MRI) because of a damaged blood-brain barrier. Sodium fluorescein is a dye that accumulates in areas of the central nervous system with a damaged BBB. Given the pattern of MRI contrast enhancement of the majority of IMSCTs, the use of this fluorescent tracer could improve tumor visualization and quality of resection. In this article, we present the first experience with the application of fluorescein-guided technique for surgical removal of IMSCTs. Methods Eleven patients (6 men, 5 women; mean age, 50.1 years), harboring 5 ependymomas, 3 hemangioblastomas, 1 astrocytoma, 1 pilocytic astrocytoma, and 1 glioneuronal tumor forming rosettes were included. Sodium fluorescein (5 mg/kg) was injected immediately after patient intubation. Tumors were removed with microsurgical technique and standard neurophysiological monitoring, under YELLOW 560 filter (Pentero 900) visualization. Surgical reports were reviewed regarding usefulness and grade of fluorescein staining. Postoperative MRI was performed within 72 hours after surgery, and postoperative clinical outcome was registered. Results No adverse events were registered. Fluorescent staining was reported in 9 of 11 cases (82{\%}), all of them enhancing on preoperative MRI (100{\%} of ependymomas, 100{\%} of pilocytic astrocytomas, 100{\%} of hemangioblastomas). No fluorescence was reported in 1 astrocytoma and 1 glioneuronal tumor–forming rosette. Intraoperative fluorescence was considered helpful for tumor resection in 9 of 11 cases (82{\%}). Gross total resection was obtained in 8 of 11 cases (72.7{\%}). Conclusions Our results suggest that fluorescein-guided surgery is a safe and effective technique that can be used during the surgical resection of IMSCTs presenting with contrast-enhancement on preoperative MRI.",
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AU - Akçakaya, Mehmet Osman

AU - de Laurentis, Camilla

AU - Hamamcioglu, Mustafa Kemal

AU - Broggi, Morgan

AU - Brawanski, Alexander

AU - Falco, Jacopo

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