Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Beijing Institute of Radiation Medicine, Beijing, China.
Int Rev Neurobiol. 2020;151:139-154. doi: 10.1016/bs.irn.2020.03.004. Epub 2020 May 13.
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.
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.
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.
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.
荧光素钠（FL）被广泛用作脑肿瘤切除的荧光示踪剂。然而，荧光素引导的脊髓胶质瘤切除仅偶尔有报道。评估荧光素引导手术切除脊髓胶质瘤的安全性、特征和实用性。
2015 年 1 月至 2018 年 12 月，220 例 227 例脊髓胶质瘤患者采用蔡司 Pentero 900 手术显微镜（内置 YELLOW 560 滤光片）进行 FL 引导切除。分析 FL 评估和临床结果。
本组无 FL 相关并发症。161 例（70.93%）胶质瘤表现为全肿瘤荧光，46 例（20.26%）表现为结节状荧光，20 例（8.81%）无荧光。217 例（95.59%）胶质瘤的术中荧光与术前增强磁共振成像高度相关，除 8 例室管膜瘤、1 例毛细胞星形细胞瘤和 1 例弥漫性中线胶质瘤外。227 例脊髓胶质瘤中，78.85%（179/227）达到大体全切除，其中 94.30%（149/158）为室管膜瘤，43.48%（30/69）为星形细胞瘤和少突胶质细胞瘤。最终临床随访时，75 例（33.04%）患者的脊髓功能明显改善，105 例（46.26%）稳定，47 例（20.70%）恶化。
FL 是一种安全、有用的实时工具，可增强增强肿瘤边界或残留肿瘤，从而提高对比度增强肿瘤的大体全切除率。
