de Laurentis Camilla, Höhne Julius, Cavallo Claudio, Restelli Francesco, Falco Jacopo, Broggi Morgan, Bosio Lorenzo, Vetrano Ignazio G, Schiariti Marco, Zattra Costanza M, Ferroli Paolo, Schebesch Karl-Michael, Acerbi Francesco
Department of Neurosurgery, Carlo Besta Institute of Neurology, IRCCS and Foundation, Milan, Italy.
Department of Neuropathology and Neurosurgery, Regensburg University Hospital, Regensburg, Germany.
J Neurosurg Sci. 2019 Dec;63(6):679-687. doi: 10.23736/S0390-5616.19.04601-0. Epub 2019 Apr 23.
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.
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.
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.
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.
手术在儿科中枢神经系统(CNS)肿瘤治疗中具有重要作用,因为积极切除与预后相关。由于荧光素钠(SF)可在血脑屏障受损区域蓄积,它可能是一种有效的工具,可用于提高术前MRI增强肿瘤的切除范围。本研究旨在系统评估SF在儿科患者中的应用价值。
在两个中心收集患者数据,一个在意大利,另一个在德国。在麻醉诱导时,静脉注射SF(5mg/kg)。手术使用YELLOW560滤光片进行。根据外科医生的判断,荧光强度分为明亮、中等或无;此外,在肿瘤切除中,SF的使用被判定为“有帮助”、“无帮助”或“非必需”。
共确定24例患者接受27次手术。27例手术中有21例(77.8%)报告荧光为明亮或中等,27例中有2例(7.4%)无荧光,27例中有4例(14.8%)数据缺失。25例术前MRI显示有对比增强的手术中有21例(84%)术中报告有荧光。27例手术中有14例(51.8%)认为SF“有帮助”;27例中有2例(7.4%)“无帮助”;27例中有7例(25.9%)“非必需”。27例中有4例(14.8%)数据缺失。未记录到SF的不良反应。
SF可被视为一种有效且安全的工具,用于改善儿科患者术前MRI增强肿瘤的可视化。需要未来的前瞻性研究来证实这些初步数据。