Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France.
Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
Childs Nerv Syst. 2023 Jun;39(6):1451-1462. doi: 10.1007/s00381-022-05772-5. Epub 2022 Dec 2.
Sodium fluorescein (SF) is routinely used in several centers as a valid intraoperative adjunct in adult oncological neurosurgery. Its use in pediatric neurosurgery is increasing, although its role is not yet well-defined in children. We reviewed the current literature in order to evaluate the use of SF in children with CNS and PNS lesions.
For this systematic review, we searched PubMed, Scopus, and Embase databases, and forward and backward citations for studies published between database inception and July 31st, 2022. We included any article type or congress abstract adding at least a new case, without restrictions of language or publication status, concerning the use of SF in neurosurgical procedures in patients under 18 years of age. We excluded studies concerning purely vascular cases and cerebrospinal fluid leaks.
Of 4094 records identified, 19 articles were eligible and included for further analysis. As per July 31st, 2022, at least 119 patients aged from 11 months to 17.9 years underwent surgery with SF. No serious adverse events were reported. A large variety of tumor types was operated, in most cases resected under the specific YELLOW 560 nm filter after a low-dose SF injection (2-5 mg/kg) at the end of anesthesia induction. SF was reported particularly useful in gangliogliomas and pilocytic astrocytomas.
DISCUSSION/CONCLUSION: Given its easy-to-use profile, low cost, and safety, SF seems to be a feasible and valid adjunct in the pediatric population when aiming at individuating a biopsy target or maximizing extent of resection, particularly in some tumor types. Further studies are required to strengthen the evidence on its impact on outcomes.
在几个中心，荧光素钠 (SF) 被常规用作成人肿瘤神经外科术中有效的辅助手段。其在儿科神经外科中的应用正在增加，尽管其在儿童中的作用尚未明确。我们回顾了目前的文献，以评估 SF 在 CNS 和 PNS 病变儿童中的应用。
为了进行这项系统评价，我们在 PubMed、Scopus 和 Embase 数据库中进行了搜索，并对截至 2022 年 7 月 31 日的研究进行了前向和后向引文搜索。我们纳入了任何类型的文章或会议摘要，这些文章或摘要至少增加了一个新病例，不限制语言或发表状态，涉及 18 岁以下患者在神经外科手术中使用 SF。我们排除了仅涉及血管病例和脑脊液漏的研究。
在 4094 条记录中，有 19 篇文章符合条件并纳入进一步分析。截至 2022 年 7 月 31 日，至少有 119 名年龄在 11 个月至 17.9 岁的患者接受了 SF 手术。没有报告严重不良事件。手术类型多种多样，大多数情况下，在麻醉诱导结束时，以低剂量 SF 注射（2-5mg/kg）后，在特定的 YELLOW 560nm 滤光片下切除肿瘤。SF 被报道在神经节细胞瘤和毛细胞星形细胞瘤中特别有用。
讨论/结论：鉴于其易于使用、成本低和安全性，SF 似乎是儿科人群中一种可行且有效的辅助手段，当旨在确定活检目标或最大限度地扩大切除范围时，尤其是在某些肿瘤类型中。需要进一步的研究来加强其对结果影响的证据。
