Fluorescence-guided surgery of brain abscesses

Abstract

Objectives: Fluorescein Sodium (FL) enhances areas in the brain with a disrupted blood brain barrier (BBB). Solitary brain abscesses (BA) are characterized by the pathognomonic finding of BBB disruption. Consequently, FL may have the potential to improve the intra-operative visualization of BA. Here, we report a series of patients with BA that where treated surgically after application of FL in combination with a dedicated light filter integrated in the surgical microscope.

Methods: 7 patients (4 female, 3 male; mean age 53.8 years) with BA were included, all of them gave written informed consent. 5mg/kg bodyweight of FL was administered via the central venous line at induction of anesthesia, approximately 30-45min prior to surgery. We screened the surgical reports for any statement concerning the intensity of fluorescent staining.

Results: Fluorescent staining was bright in all patients. Surgical removal of all parts of the BA, aspiration of pus and dissection of the capsule, were performed in the fluorescence-mode under the filtered light. We encountered no adverse events.

Conclusion: The accumulation of FL resulted in brilliant visualization of the infected area under the YELLOW 560nm filter. This small clinical study adds to the rapidly emerging clinical experiences of the use of fluorescein in neurosurgery, even for non-neoplastic lesions. However, prospective and randomized clinical trials are still necessary to establish the beneficial use of FL.

Keywords: Brain abscess; Fluorescein sodium; Fluorescence-guided surgery; YELLOW 560nm filter.