Neurosurgery Department, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Neurosurgery Department, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil.
World Neurosurg. 2023 Jun;174:62. doi: 10.1016/j.wneu.2023.02.144. Epub 2023 Mar 10.
Fluorescein (FS) was first used to visualize malignant brain tumors in 1948. FS accumulates in malignant gliomas where the blood-brain barrier is disrupted and provides intraoperative visualization that is similar to preoperative contrast-enhanced T1 images in which gadolinium accumulation is seen. FS can be viewed under white light, but the use of an operating microscope fitted with a dedicated filter (YELLOW 560 nm Filter, Carl Zeiss Meditec, Oberkochen, Germany) allows us to significantly reduce the dose needed to highlight tumoral tissue. FS is excited at 460-500 nm and emits a green, fluorescent emission wavelength at 540-690 nm. It is virtually free of side effects and has low costs (approximately 6.9 USD each vial: Brazil). Video 1 presents a case of a 63-year-old man who underwent a left temporal craniotomy to remove a temporal polar tumor. The FS is administered at the time of anesthesia before a craniotomy. The tumor was then removed with standard microneurosurgical technique by the alternating use of white light and YELLOW 560 nm filter illumination. The use of FS was found "helpful" to discriminate the brain tissue and tumor tissue (bright yellow). Fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows complete resection of high-grade gliomas.
荧光素（FS）于 1948 年首次用于可视化恶性脑肿瘤。FS 在血脑屏障被破坏的恶性胶质瘤中积聚，并提供术中可视化效果，类似于术前增强 T1 图像中观察到的钆积聚。FS 可以在白光下观察，但使用配备专用滤光片的手术显微镜（德国卡尔蔡司 Meditec 的 YELLOW 560nm 滤光片）可以显著减少突出肿瘤组织所需的剂量。FS 在 460-500nm 处被激发，发射出 540-690nm 的绿色荧光发射波长。它几乎没有副作用，成本低（每瓶约 6.9 美元：巴西）。视频 1 展示了一名 63 岁男性的病例，他接受了左颞骨开颅术以切除颞极肿瘤。FS 在开颅前麻醉时给予。然后，使用标准的微创神经外科技术，通过交替使用白光和 YELLOW 560nm 滤光片照明来切除肿瘤。使用 FS 被发现有助于区分脑组织和肿瘤组织（亮黄色）。手术显微镜上的专用滤光片引导 FS 的技术是安全的，可以实现高级别胶质瘤的完全切除。
