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  • Use of Sodium Fluorescein with the 560 nm Filter Microscope for Brain Tumor Surgery

    Final Number:

    Mustafa Kemal Hamamcioglu MD, Burcu Goker MD, Mehmet Osman Akcakaya MD, Osman Arıca MD, Talat Kiris MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Extent of the resection with the use of 5-aminolevulinic acid (ALA) and blue filter 400 nm have been shown to be increased in recent studies about gliomas. However, the use of 5-ALA may have side effects and is an expensive application. In brain, areas of disrupted blood-brain barrier and tumor tissues are intensily staining with Sodium fluorescein (FL) . Tumor tissue can be easily distinguished from normal tissue and extensive or complete resection may be possible with the new microscope system (YELLOW 560 nm, Pentero 900, Carl Zeiss Meditec, Oberkochen, Germany). In this report, we present our initial experience with the use of low dose FL and 560 nm filter YELLOW microscope system in 10 patients with brain tumors.

    Methods: 200 mg FL (3-4 mg / kg) was administered intravenously in 10 patients who underwent a total of 11 surgeries.

    Results: Neuronavigation (Medtronic, stealthstation® S7®) was used in all instances and neuromonitorization was used in selected cases according to the tumor location. The ages of the patients were between 28 and 78 (mean age 51). There were five female and five male patients in the study group. Histopathological evaluation revealed gliomas in 8 patients (2 of grade I and II,2 of grade III and 2 of grade IV ), while two tumor metastasis was detected in a single patient and one central nervous system lymphoma was encountered in one patient. All high grade tumors (grade III&IV), lymphoma and metastases showed intense florescein staining which helped the detection of these tumors and increased the extent of the resection, whereas low grade tumors did not or very slightly stained with FL. No FL related side effects, mortality and morbidity were observed in this series.

    Conclusions: Operation with the use of low-dose FL and a new generation of YELLOW 560 filter microscopes was found to be safe and feasible.

    Patient Care: We think, that the extent of resection of brain tumors may be increased by the use of this technology, which eventually have a positive impact on patient prognosis and disease free survival.Randomized studies with larger number of patients should be planned in order to define the effects of the use of sodium fluorescein and 560 nm filter YELLOW microscope system on the extent of the brain tumor resection.

    Learning Objectives: With this poster presentation the partcipants should emphasize the importance of the sodium fluorescein and 560 nm filter YELLOW microscope system on the brain tumor resection.


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