Use of Sodium Fluorescein in Meningioma Surgery Performed Under the YELLOW-560 nm Surgical Microscope Filter: Feasibility and Preliminary Results

Abstract

Objective: To evaluate the feasibility of sodium fluorescein (Na-Fl)-guided surgery involving the use of the PENTERO 900 surgical microscope equipped with the YELLOW-560 nm filter and low-dose Na-FL (200 mg/2-4 mg/kg) in meningioma surgery.

Patients and methods: The study included 30 patients with newly diagnosed or recurrent meningiomas who underwent Na-Fl-guided surgery between April 2015 and December 2016. Clinical features, surgical observations, extent of resection, and tumor histopathology were retrospectively analyzed. The Na-Fl enhancement pattern was assessed as "no enhancement," "diffuse homogenous enhancement," or "low heterogeneous enhancement."

Results: There were 30 meningiomas among the 30 patients. In 25 patients, Na-Fl was used for tumor demarcation, whereas in 5 patients, it was used for videoangiography. In this series, 88% of tumors showed diffuse homogeneous Na-Fl enhancement during the operation. The resection rate of the meningiomas was 87%. In 5 patients, in whom Na-Fl was used for videoangiography, the approach was useful to evaluate Na-Fl-stained vessels for patency and to understand their relationship with the tumor. No adverse events were encountered with regard to Na-Fl use.

Conclusions: Na-Fl guidance with the use of the YELLOW-560 filter is safe and effective during meningioma surgery.

Keywords: Convexity; Fluorescence-guided surgery; Meningioma; Skull base; Sodium fluorescein; Surgical microscope; Videoangiography; YELLOW 560.