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The utilization of sodium fluorescein in pediatric brain stem gliomas: a case report and review of the literature

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Abstract

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.

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References

  1. Acerbi F, Broggi M, Eoli M, Anghileri E, Cavallo C, Boffano C, Cordella R, Cuppini L, Pollo B, Schiariti M, Visintini S, Orsi C, la Corte E, Broggi G, Ferroli P (2014) Is fluorescein-guided technique able to help resection of high-grade gliomas? Neurosurg Focus 36(5):E5

    Article  Google Scholar 

  2. Burkhard C, Di Patre PL, Schuler D, Schuler G, Yasargil MG, Yonekawa Y et al (2003) A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 98:1170–1174

    Article  Google Scholar 

  3. Chen B, Wang H, Ge P, Zhao J, Li W, Gu H, Wang G, Luo Y, Chen D (2012) Gross Total resection of glioma with the intraoperative fluorescence-guidance of fluorescein sodium. Int J Med Sci 9(8):708–714

    Article  CAS  Google Scholar 

  4. Coelho J, Nunes S, Salgado D (2015) Spontaneous malignant transformation of a pilocytic astrocytoma of cerebellum. Child Neurol Open 2(1):2329048X1456681

    Article  Google Scholar 

  5. Collins VP, Jones DTW, Giannini C (2015) Pilocytic astrocytoma: pathology, molecular mechanisms and markers. Acta Neuropathol 129(6):775–788

    Article  CAS  Google Scholar 

  6. 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

    Article  Google Scholar 

  7. Göker B, Kırış T (2019) Sodium fluorescein–guided brain tumor surgery under the YELLOW-560-nm surgical microscope filter in pediatric age group: feasibility and preliminary results. Childs Nerv Syst 35(3):429–443

    Article  Google Scholar 

  8. Hamamcıoğlu MK, Akçakaya MO, Göker B, Kasımcan MÖ, Kırış T (2016) The use of the YELLOW 560nm surgical microscope filter for sodium fluorescein-guided resection of brain tumors: our preliminary results in a series of 28 patients. Clin Neurol Neurosurg 143:39–45

    Article  Google Scholar 

  9. Hefti M, von Campe G, Moschopulos M, Siegner A, Looser H, Landolt H (2008) 5-aminolevulinic acid induced protoporphyrin IX fluorescence in high-grade glioma surgery: a one-year experience at a single institution. Swiss Med Wkly 138:180–185

    CAS  PubMed  Google Scholar 

  10. Höhne J, Brawanski A, Schebesch K-M (2017) Fluorescence-guided surgery of brain abscesses. Clin Neurol Neurosurg 155:36–39

    Article  Google Scholar 

  11. Krammer B, Plaetzer K (2008) ALA and its clinical impact, from bench to bedside. Photochem Photobiol Sci 7:283–289

    Article  CAS  Google Scholar 

  12. Lane BC, Cohen-Gadol AA (2013) Fluorescein fluorescence use in the management of intracranial neoplastic and vascular lesions: a review and report of a new technique. Curr Drug Discov Technol 10(2):160–169

    Article  CAS  Google Scholar 

  13. Lee JY, Thawani JP, Pierce J, Zeh R, Martinez-Lage M, Chanin M, Singhal S (2016) Intraoperative near-infrared optical imaging can localize gadolinium-enhancing gliomas during surgery. J Neurosurg 79(6):856–871

    Article  Google Scholar 

  14. Li Y, Rey-Dios R, Roberts DW, Valdes PA, Cohen-Gadol AA, Intraoperative Fluorescence-Guided Resection of High-Grade Gliomas (2014) A comparison of the present techniques and evolution of future strategies. World Neurosurg 82(1/2):175–185

    Article  Google Scholar 

  15. Lin F-H, Zhang X-h, Zhang J, He Z-q, Duan H, Ke C, Sai K, Jiang X-b, al-Nahari F, Xi S-y, Mou Y-g (2018) Fluorescein sodium-guided biopsy or resection in primary central nervous system lymphomas with contrast-enhancing lesion in MRI. J Neuro-Oncol 139(3):757–765

    Article  Google Scholar 

  16. Lovato RM, Vitorino Araujo JL, Esteves Veiga JC (2017) Low-cost device for fluorescein-guided surgery in malignant brain tumor. World Neurosurg 104:61–67

    Article  Google Scholar 

  17. Neira JA, Ung TH, Sims JS, Malone HR, Chow DS, Samanamud J et al (2017) Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance. J Neurosurg 127:111–122

    Article  Google Scholar 

  18. Ohgaki H, Kleihues P (2005) Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol 64:479–489

    Article  CAS  Google Scholar 

  19. Okuda T, Kataoka K, Yabuuchi T, Yugami H, Kato A (2010) Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium. J Clin Neurosci 17(1):118–121

    Article  Google Scholar 

  20. Okuda T, Yoshioka H, Kato A (2012) Fluorescence-guided surgery for glioblastoma multiforme using high-dose fluorescein sodium with excitation and barrier filters. J Clin Neurosci 19(12):1719–1722

    Article  Google Scholar 

  21. Panciani PP, Fontanella M, Schatlo B, Garbossa D, Agnoletti A, Ducati A, Lanotte M (2012) Fluorescence and image guided resection in high grade glioma. Clin Neurol Neurosurg 114:37–41

    Article  Google Scholar 

  22. Rey-Dios R, Cohen-Gadol AA (2013) Intraoperative fluorescence for resection of hemangioblastomas. Acta Neurochir 155(7):1287–1292

    Article  Google Scholar 

  23. Roberts DW, Valdés PA, Harris BT, Fontaine KM, Hartov A, Fan X, Ji S, Lollis SS, Pogue BW, Leblond F, Tosteson TD, Wilson BC, Paulsen KD (2011) Coregistered fluorescence-enhanced tumor resection of malignant glioma: relationships between d-aminolevulinic acid-induced protoporphyrin IX fluorescence, magnetic resonance imaging enhancement, and neuropathological parameters. J Neurosurg 114:595–603

    Article  Google Scholar 

  24. Schebesch K-M, Hoehne J, Hohenberger C, Acerbi F, Broggi M, Proescholdt M, Wendl C, Riemenschneider MJ, Brawanski A (2015) Fluorescein sodium-guided surgery in cerebral lymphoma. Clin Neurol Neurosurg 139:125–128

    Article  Google Scholar 

  25. Schebesch K-M, Brawanski A, Hohenberger C, Höhne J (2016) Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future project. Turk Neurosurg 26:185–194

    PubMed  Google Scholar 

  26. Shinoda J, Yano H, Yoshima S, Okumura A, Kaku Y, Iwama T, Sakai N (2003) Fluorescence-guided resection of glioblastoma multiform by using high-dose fluorescein sodium. J Neurosurg 99:597–603

    Article  Google Scholar 

  27. Shinoda J, Yano H, Yoshimura S-I, Okumura A, Kaku Y, Iwama T, Sakai N (2003) Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. J Neurosurg 99(3):597–603

    Article  Google Scholar 

  28. Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ (2000) Fluorescence-guided resection of glio- blastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg 93:1003–1013

    Article  CAS  Google Scholar 

  29. Stummer W, Reulen HJ, Novotny A, Stepp H, Tonn JC (2003) Fluorescence-guided resections of malignant gliomas-an overview. Acta Neurochir 88:9–12

    CAS  Google Scholar 

  30. Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401

    Article  CAS  Google Scholar 

  31. Tonn JC, Stummer W (2008) Fluorescence-guided resection of malignant gliomas using 5-aminolevulinic acid: practical use, risks, and pitfalls. Clin Neurosurg 55:20–26

    PubMed  Google Scholar 

  32. Tsugu A, Ishizaka H, Mizokami Y, Osada T, Baba T, Yoshiyama M, Nishiyama J, Matsumae M (2011) Impact of the combination of 5-aminolevulinic acid-induced fluorescence with intraoperative magnetic resonance imaging-guided surgery for glioma. World Neurosurg 76:120–127

    Article  Google Scholar 

  33. Valdes PA, Fan X, Ji S, Harris BT, Paulsen KD, Roberts DW (2010) Estimation of brain deformation for volumetric image updating in protoporphyrin IX fluorescence-guided resection. Stereotact Funct Neurosurg 88:1–10

    Article  Google Scholar 

  34. Valdes PA, Kim A, Brantsch M, Niu C, Moses ZB, Tosteson TD, Wilson BC, Paulsen KD, Roberts DW, Harris BT (2011) Delta-aminolevulinic acid-induced protoporphyrin IX concentration correlates with histopathologic markers of malignancy in human gliomas: the need for quantitative fluorescence-guided resection to identify regions of increasing malignancy. J Neuro-Oncol 13:846–856

    Article  CAS  Google Scholar 

  35. Valdes PA, Leblond F, Kim A, Harris BT, Wilson BC, Fan X, Tosteson TD, Hartov A, Ji S, Erkmen K, Simmons NE, Paulsen KD, Roberts DW (2011) Quantitative fluorescence in intra- cranial tumor: implications for ALA-induced PpIX as an intraoperative biomarker. J Neurosurg 115:11–17

    Article  Google Scholar 

  36. Yano H, Nakayama N, Ohe N, Miwa K, Shinoda J, Iwama T (2017) Pathological analysis of the surgical margins of resected glioblastomas excised using photodynamic visualization with both 5-aminolevulinic acid and fluorescein sodium. J Neuro-Oncol 133(2):389–397

    Article  CAS  Google Scholar 

  37. Zhang N, Tian H, Huang D et al (2017) Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant gliomas: our first 38 cases experience. Biomed Res Int 2017:1–10

    CAS  Google Scholar 

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Authors and Affiliations

  1. Vassar College, 124 Raymond Avenue, Poughkeepsie, NY, 12603, USA

    Cameron M. Erdman

  2. New Jersey Pediatric Neuroscience Institute, 131 Madison Avenue, Morristown, NJ, 07960, USA

    Catherine Christie, Catherine A. Mazzola & Luke Tomycz

  3. Rutgers University, 90 Bergen Street, Newark, NJ, 07101, USA

    M. Omar Iqbal

Authors
  1. Cameron M. Erdman
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  2. Catherine Christie
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  3. M. Omar Iqbal
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  4. Catherine A. Mazzola
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  5. Luke Tomycz
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Correspondence to Luke Tomycz.

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Erdman, C.M., Christie, C., Iqbal, M.O. et al. The utilization of sodium fluorescein in pediatric brain stem gliomas: a case report and review of the literature. Childs Nerv Syst 37, 1753–1758 (2021). https://doi.org/10.1007/s00381-020-04857-3

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  • DOI: https://doi.org/10.1007/s00381-020-04857-3

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