Introduction

A major challenge in the surgical resection of brainstem tumors is distinguishing tumor from normal tissue. One approach for addressing this problem is the use of fluorescent tracers such as sodium fluorescein (NaFl). NaFl disseminates through a disruption in the blood-brain barrier (BBB) and accumulates in the extracellular space of brain tumors. Intraoperative fluorescence microscopy can be performed to identify tumor tissue and avoid damage to adjacent, normal tissue. Here, we present the case of a 16-year-old male who underwent a left retrosigmoid craniotomy with splitting of the tentorium to remove a large exophytic brainstem tumor involving the cerebellar peduncle and with superior extension into the midbrain and thalamus.

Objectives

The primary objective of this study was to investigate the effectiveness of sodium fluorescein as an intraoperative technique and evaluate its potential benefit for resection of tumors in eloquent regions in the pediatric population. To do so, we focused on a case study approach; however, we also performed a literature review and evaluated different intraoperative fluorescent techniques and their benefits for tumor resection.

Methods

We performed a literature search using PubMed and Google Scholar by the key words “sodium fluorescein,” “brain stem tumor,” and “central nervous system neoplasms.” Twenty-nine articles including both pediatric and adult populations were selected for analysis and qualitative review.

Results

In this case study, sodium fluorescein helped the surgeons to identify and obtain a gross total resection of a large brainstem tumor. The marker was especially helpful for discerning the inferior pole of the tumor buried inconspicuously in cerebellar tissue. We evaluate different fluorescent tracers, 5-ALA and ICG, and discuss their application and benefits in tumor resection surgery. We present different cases that found sodium fluorescein to be helpful in achieving a gross total resection.

Conclusion

The application of sodium fluorescein proved to be a safe and effective technique for the resection of brain stem tumors as shown in this case study. It helped to expose concealed areas and illuminate the tumor capsule. Further studies should test the clinical use of sodium fluorescein on brain stem tumor resection.

中文翻译：

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荧光素钠在小儿脑干胶质瘤中的应用：1例报告并文献复习。

介绍

脑干肿瘤手术切除的一个主要挑战是区分肿瘤与正常组织。解决这个问题的一种方法是使用荧光示踪剂，如荧光素钠 (NaFl)。NaFl 通过破坏血脑屏障 (BBB) 进行传播，并在脑肿瘤的细胞外空间积聚。可以进行术中荧光显微镜检查以识别肿瘤组织并避免损伤邻近的正常组织。在这里，我们介绍了一个 16 岁男性的案例，他接受了左乙状结肠后开颅手术，并分裂了小脑幕，以去除一个涉及小脑脚并向上延伸到中脑和丘脑的大的外生脑干肿瘤。

目标

本研究的主要目的是研究荧光素钠作为术中技术的有效性，并评估其在儿科人群中切除肿瘤的潜在益处。为此，我们专注于案例研究方法；然而，我们还进行了文献回顾并评估了不同的术中荧光技术及其对肿瘤切除的益处。

方法

我们使用 PubMed 和 Google Scholar 通过关键词“荧光素钠”、“脑干肿瘤”和“中枢神经系统肿瘤”进行了文献搜索。包括儿科和成人人群在内的 29 篇文章被选中进行分析和定性审查。

结果

在这个案例研究中，荧光素钠帮助外科医生识别并获得了大脑干肿瘤的全切除术。该标记物对于识别隐藏在小脑组织中不显眼的肿瘤下极特别有帮助。我们评估了不同的荧光示踪剂、5-ALA 和 ICG，并讨论了它们在肿瘤切除手术中的应用和益处。我们提出了不同的案例，这些案例发现荧光素钠有助于实现全切。

结论

如本案例研究所示，荧光素钠的应用被证明是一种安全有效的脑干肿瘤切除技术。它有助于暴露隐藏区域并照亮肿瘤包膜。进一步的研究应该测试荧光素钠在脑干肿瘤切除术中的临床应用。