Sodium- Fluorescein Guided Surgery in Peripheral Nerve Sheath Tumors (PNST): First Experience in 10 Cases of Schwannoma.

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Sodium- Fluorescein Guided Surgery in Peripheral Nerve Sheath Tumors (PNST): First Experience in 10 Cases of Schwannoma.

World Neurosurg. 2019 Jan 17;:

Authors: Pedro MT, Eissler A, Schmidberger J, Kratzer W, Wirtz CR, Antoniadis G, Koenig RW

Abstract
OBJECTIVE: The intravenous application of sodium fluorescein (SF) for brain tumor surgery goes back to the late 1940´s. The development of specific fluorophore filters significantly reduced the required dosage of SF and therefore diminished possible side effects. The present study investigates the application of SF in benign PNST, concentrating on its feasibility during microsurgical removal.
METHODS: The single center study includes 10 consecutive schwannoma cases operated on between 09/2016 and 03/2017. Inclusion criteria were defined as age ≥ 18 years, preoperative MRI with suspicion of schwannoma and final histopathological confirmation of schwannoma. Exclusion criteria were a history of intolerance to SF and renal insufficiency. The microsurgical part of each surgery was video recorded and the collected material retrospectively analyzed. RGB (red, green, blue) values of various regions of interest (ROI) set on tumor and normal nerve of each patient were evaluated using ImageJ, an open platform for scientific image analysis.
RESULTS: Digital video analysis confirmed the intraoperative impression of increased fluorescence of the tumor in contrast to normal nerve tissue. As the color yellow is predominantly a mixture of red and green, values of these colors were significantly increased in schwannomas compared to normal nerve tissue (p= 0.0003, p= 0.0023).
CONCLUSIONS: SF reveals increased fluorescence in schwannomas compared to normal nerve tissue. Intraoperative differentiation of tumor and normal nerve tissue becomes possible using low dose of SF (0.5 - 1 mg/kg). No side effects occurred. Secure microsurgical preparation is feasible during application of the Yellow 560 nm filter.

PMID: 30660884 [PubMed - as supplied by publisher]

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