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01-12-2024 | Spinal Tumor | Review

Fluorescence-guided resection of intradural spinal tumors: a systematic review and meta-analysis

Authors: Ibrahem Albalkhi, Areez Shafqat, Othman Bin-Alamer, Abdul Rahman Abou Al-Shaar, Arka N. Mallela, Ricardo J. Fernández-de Thomas, Pascal O. Zinn, Peter C. Gerszten, Constantinos G. Hadjipanayis, Hussam Abou-Al-Shaar

Published in: Neurosurgical Review | Issue 1/2024

Abstract

Intradural spinal tumors present significant challenges due to involvement of critical motor and sensory tracts. Achieving maximal resection while preserving functional tissue is therefore crucial. Fluorescence-guided surgery aims to improve resection accuracy and is well studied for brain tumors, but its efficacy has not been fully assessed for spinal tumors. This meta-analysis aims to delineate the efficacy of fluorescence guidance in intradural spinal tumor resection. The authors performed a systematic review in four databases. We included studies that have utilized fluorescence agents, 5-aminolevulinic acid (5-ALA) or sodium fluorescein, for the resection of intradural spinal tumors. A meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 12 studies involving 552 patients undergoing fluorescence-guided intradural spinal tumor resection were included. Meningiomas demonstrated a 98% fluorescence rate and were associated with a homogenous florescence pattern; however, astrocytomas had variable fluorescence rate with pooled proportion of 70%. There was no significant difference in gross total resection (GTR) rates between fluorescein and 5-ALA (94% vs 84%, p = .22). Pre-operative contrast enhancement was significantly associated with intraoperative fluorescence with fluorescein. Intramedullary tumors with positive intraoperative fluorescence were significantly associated with higher GTR rates (96% vs 73%, p = .03). Utilizing fluorescence guidance during intradural spinal tumor resection holds promise of improving intraoperative visualization for specific intradural spinal tumors. Meningiomas and ependymomas have the highest fluorescence rates especially with sodium fluorescein; on the other hand, astrocytomas have variable fluorescence rates with no superiority of either agent. Positive fluorescence of intramedullary tumors is associated with a higher degree of resection.

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Title: Fluorescence-guided resection of intradural spinal tumors: a systematic review and meta-analysis
Authors: Ibrahem Albalkhi
Areez Shafqat
Othman Bin-Alamer
Abdul Rahman Abou Al-Shaar
Arka N. Mallela
Ricardo J. Fernández-de Thomas
Pascal O. Zinn
Peter C. Gerszten
Constantinos G. Hadjipanayis
Hussam Abou-Al-Shaar
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Spinal Tumor
Ependymoma
Ependymoma
Ependymoma
Meningioma
Meningioma
Astrocytoma
Astrocytoma
Astrocytoma
Published in: Neurosurgical Review / Issue 1/2024
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-023-02230-x

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Fluorescence-guided resection of intradural spinal tumors: a systematic review and meta-analysis

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