Fluorescein-guided surgery for spinal gliomas: Analysis of 220 consecutive cases

Zhenxing Sun, Linkai Jing, Yingwei Fan, Huifang Zhang, Lin Chen, Guihuai Wang, Hari Shanker Sharma*, James Wang

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

14 Citations (Scopus)

Abstract

Objective: Sodium fluorescein (FL) is widely used as a fluorescent tracer for brain tumor resection. However, FL-guided resection of spinal gliomas has been reported only occasionally. To evaluate the safety, characteristics, and usefulness of FL-guided surgery in the resection of spinal glioma. Methods: Between January 2015 and December 2018, 220 consecutive patients with 227 spinal gliomas underwent FL-guided resection using the Zeiss Pentero 900 surgical microscope with an integrated YELLOW 560 filter. FL evaluation and clinical outcomes were analyzed. Results: No FL-related complications occurred in this series. Entire tumor fluorescence was observed in 161 (70.93%) gliomas, nodular fluorescence in 46 (20.26%) tumors, and no fluorescence in 20 (8.81%) tumors. The intraoperative fluorescence of 217 (95.59%) gliomas was highly correlated with preoperative contrast-enhancing magnetic resonance imaging, except in eight ependymomas, one pilocytic astrocytoma, and one diffuse midline glioma. Gross-total resection was achieved in 78.85% (179/227) of spinal gliomas, including 94.30% (149/158) ependymal tumors and 43.48% (30/69) astrocytic and oligodendroglial tumors. At the final clinical follow-up, the spinal function of 75 (33.04%) patients showed significant improvement, 105 (46.26%) showed stabilization, and 47 (20.70%) showed deterioration. Conclusion: FL is a safe and useful real-time tool that could enhance tumor borders or residual tumors and hence increase the gross-total resection rate in cases with contrast-enhanced tumors.

Original languageEnglish
Title of host publicationNovel Therapeutic Advances in Glioblastoma
EditorsIgor Bryukhovetskiy, Aruna Sharma, Zhiqiang Zhang, Hari Shanker Sharma
PublisherAcademic Press Inc.
Pages139-154
Number of pages16
ISBN (Print)9780128211144
DOIs
Publication statusPublished - 2020
Externally publishedYes

Publication series

NameInternational Review of Neurobiology
Volume151
ISSN (Print)0074-7742
ISSN (Electronic)2162-5514

Keywords

  • Fluorescein
  • Magnetic resonance imaging
  • Microsurgery
  • Spinal glioma
  • Treatment

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Sun, Z., Jing, L., Fan, Y., Zhang, H., Chen, L., Wang, G., Sharma, H. S., & Wang, J. (2020). Fluorescein-guided surgery for spinal gliomas: Analysis of 220 consecutive cases. In I. Bryukhovetskiy, A. Sharma, Z. Zhang, & H. S. Sharma (Eds.), Novel Therapeutic Advances in Glioblastoma (pp. 139-154). (International Review of Neurobiology; Vol. 151). Academic Press Inc.. https://doi.org/10.1016/bs.irn.2020.03.004