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25-04-2024 | Glioma | Research

Role of sodium fluorescein in pediatric low-grade glioma surgery: an update

Authors: Camilla de Laurentis, Claudia Pasquali, Pierre-Aurélien Beuriat, Carmine Mottolese, Alexandru Szathmari, Matthieu Vinchon, Federico Di Rocco

Published in: Child's Nervous System

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Abstract

Purpose

Complete surgical resection is still the mainstay in the treatment of central nervous system low-grade tumors, eventually resulting curative. The complete surgical removal of these lesions, however, may be difficult in some cases because of their infiltrative nature. Intraoperative adjuncts may be a game changer. Sodium fluorescein (SF) is among the ideal candidates as intraoperative tools to favor the actual recognition of the tumor extension, since it accumulates in areas of altered blood–brain barrier, a typical characteristic of pediatric gliomas, and has a low rate of adverse events. This work proposes an update of previous works about the evaluation of the feasibility and usefulness of a systematic use of SF in a low-grade lesion group of pediatric patients.

Methods

Pediatric patients operated on for a resection or a biopsy of a low-grade glial or glioneuronal lesion (WHO grade I and II) at our Institution between September 2021 and December 2023, with the intraoperative use of sodium fluorescein (SF), were enrolled in the study. We collected pre-operative and postoperative clinical and radiological data, intraoperative findings, and post-operative pathological diagnoses.

Results

No adverse events were registered related to the intraoperative use of SF. SF appeared useful for the localization of boundaries of tumors, especially when characterized by a high degree of infiltration or by a deep-seated location, and for the checking of possible tumor remnants at the end of surgery. A good tumor-to-healthy tissue contrast was registered when tumor visualization was in a range between 1 to 2 h and 30 min after SF injection. Possible “false positives” due to intraoperative vascular wall injury and clearance of SF from both tumor and healthy tissue were observed in some cases and still remain open issues.

Conclusions

SF is a feasible and safe intraoperative adjunct tool in the surgical removal of pediatric low-grade tumors. SF may show its usefulness especially in selected cases, such as deep-seated lesions and infiltrating tumors. Its safety profile, user-friendly management, and potential utility in both tumor resections and neuronavigated biopsies favor its wider use in the surgical treatment of pediatric low-grade tumors.
Literature
2.
go back to reference Acerbi F, Broggi M, Schebesch K-M, Höhne J, Cavallo C, De Laurentis C, Eoli M, Anghileri E, Servida M, Boffano C, Pollo B, Schiariti M, Visintini S, Montomoli C, Bosio L, La Corte E, Broggi G, Brawanski A, Ferroli P (2018) Fluorescein-guided surgery for resection of high-grade gliomas: a multicentric prospective phase II Study (FLUOGLIO). Clin Cancer Res 24:52–61. https://doi.org/10.1158/1078-0432.CCR-17-1184CrossRefPubMed Acerbi F, Broggi M, Schebesch K-M, Höhne J, Cavallo C, De Laurentis C, Eoli M, Anghileri E, Servida M, Boffano C, Pollo B, Schiariti M, Visintini S, Montomoli C, Bosio L, La Corte E, Broggi G, Brawanski A, Ferroli P (2018) Fluorescein-guided surgery for resection of high-grade gliomas: a multicentric prospective phase II Study (FLUOGLIO). Clin Cancer Res 24:52–61. https://​doi.​org/​10.​1158/​1078-0432.​CCR-17-1184CrossRefPubMed
4.
go back to reference Alkan Z, Cakir BO, Kilinç BM, Turgut S (2004) Grand mal seizure following intrathecal fluorescein use. Kulak Burun Bogaz Ihtis Derg KBB J Ear Nose Throat 13:80–83 Alkan Z, Cakir BO, Kilinç BM, Turgut S (2004) Grand mal seizure following intrathecal fluorescein use. Kulak Burun Bogaz Ihtis Derg KBB J Ear Nose Throat 13:80–83
8.
go back to reference Belykh E, Shaffer KV, Lin C, Byvaltsev VA, Preul MC, Chen L (2020) Blood-brain barrier, blood-brain tumor barrier, and fluorescence-guided neurosurgical oncology: delivering optical labels to brain tumors. Front Oncol 10 Belykh E, Shaffer KV, Lin C, Byvaltsev VA, Preul MC, Chen L (2020) Blood-brain barrier, blood-brain tumor barrier, and fluorescence-guided neurosurgical oncology: delivering optical labels to brain tumors. Front Oncol 10
10.
go back to reference Bowden SG, Neira JA, Gill BJA, Ung TH, Englander ZK, Zanazzi G, Chang PD, Samanamud J, Grinband J, Sheth SA, McKhann GM, Sisti MB, Canoll P, D’Amico RS, Bruce JN (2018) Sodium fluorescein facilitates guided sampling of diagnostic tumor tissue in nonenhancing gliomas. Neurosurgery 82:719–727. https://doi.org/10.1093/neuros/nyx271CrossRefPubMed Bowden SG, Neira JA, Gill BJA, Ung TH, Englander ZK, Zanazzi G, Chang PD, Samanamud J, Grinband J, Sheth SA, McKhann GM, Sisti MB, Canoll P, D’Amico RS, Bruce JN (2018) Sodium fluorescein facilitates guided sampling of diagnostic tumor tissue in nonenhancing gliomas. Neurosurgery 82:719–727. https://​doi.​org/​10.​1093/​neuros/​nyx271CrossRefPubMed
12.
go back to reference Diaz RJ, Dios RR, Hattab EM, Burrell K, Rakopoulos P, Sabha N, Hawkins C, Zadeh G, Rutka JT, Cohen-Gadol AA (2015) Study of the biodistribution of fluorescein in glioma-infiltrated mouse brain and histopathological correlation of intraoperative findings in high-grade gliomas resected under fluorescein fluorescence guidance. J Neurosurg 122:1360–1369. https://doi.org/10.3171/2015.2.JNS132507CrossRefPubMed Diaz RJ, Dios RR, Hattab EM, Burrell K, Rakopoulos P, Sabha N, Hawkins C, Zadeh G, Rutka JT, Cohen-Gadol AA (2015) Study of the biodistribution of fluorescein in glioma-infiltrated mouse brain and histopathological correlation of intraoperative findings in high-grade gliomas resected under fluorescein fluorescence guidance. J Neurosurg 122:1360–1369. https://​doi.​org/​10.​3171/​2015.​2.​JNS132507CrossRefPubMed
28.
go back to reference de Laurentis C, Höhne J, Cavallo C, Restelli F, Falco J, Broggi M, Bosio L, Vetrano IG, Schiariti M, Zattra CM, Ferroli P, Schebesch K-M, Acerbi F (2019) The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study. J Neurosurg Sci 63. https://doi.org/10.23736/S0390-5616.19.04601-0 de Laurentis C, Höhne J, Cavallo C, Restelli F, Falco J, Broggi M, Bosio L, Vetrano IG, Schiariti M, Zattra CM, Ferroli P, Schebesch K-M, Acerbi F (2019) The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study. J Neurosurg Sci 63. https://​doi.​org/​10.​23736/​S0390-5616.​19.​04601-0
33.
go back to reference Neira JA, Ung TH, Sims JS, Malone HR, Chow DS, Samanamud JL, Zanazzi GJ, Guo X, Bowden SG, Zhao B, Sheth SA, McKhann GM, Sisti MB, Canoll P, D’Amico RS, Bruce JN (2017) Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance. J Neurosurg 127:111–122. https://doi.org/10.3171/2016.7.JNS16232CrossRefPubMed Neira JA, Ung TH, Sims JS, Malone HR, Chow DS, Samanamud JL, Zanazzi GJ, Guo X, Bowden SG, Zhao B, Sheth SA, McKhann GM, Sisti MB, Canoll P, D’Amico RS, Bruce JN (2017) Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance. J Neurosurg 127:111–122. https://​doi.​org/​10.​3171/​2016.​7.​JNS16232CrossRefPubMed
42.
go back to reference Stummer W, Rodrigues F, Schucht P, Preuss M, Wiewrodt D, Nestler U, Stein M, Artero JMC, Platania N, Skjøth-Rasmussen J, Puppa AD, Caird J, Cortnum S, Eljamel S, Ewald C, González-García L, Martin AJ, Melada A, Peraud A, Brentrup A, Santarius T, Steiner HH (2014) Predicting the “usefulness” of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey. Acta Neurochir (Wien) 156:2315–2324. https://doi.org/10.1007/s00701-014-2234-2CrossRefPubMed Stummer W, Rodrigues F, Schucht P, Preuss M, Wiewrodt D, Nestler U, Stein M, Artero JMC, Platania N, Skjøth-Rasmussen J, Puppa AD, Caird J, Cortnum S, Eljamel S, Ewald C, González-García L, Martin AJ, Melada A, Peraud A, Brentrup A, Santarius T, Steiner HH (2014) Predicting the “usefulness” of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey. Acta Neurochir (Wien) 156:2315–2324. https://​doi.​org/​10.​1007/​s00701-014-2234-2CrossRefPubMed
Metadata
Title
Role of sodium fluorescein in pediatric low-grade glioma surgery: an update
Authors
Camilla de Laurentis
Claudia Pasquali
Pierre-Aurélien Beuriat
Carmine Mottolese
Alexandru Szathmari
Matthieu Vinchon
Federico Di Rocco
Publication date
25-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-024-06402-y