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Sodium fluorescein in pediatric oncological neurosurgery: a pilot study on 50 children

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Abstract

Background

Sodium fluorescein (SF) is currently considered a valid intraoperative adjunct in the resection of high-grade brain lesions in adults. Experiences in pediatric groups and in low-grade gliomas and other low-grade lesions are still limited in literature, and subjective evaluation of fluorescence is still a limitation.

Material and methods

This study retrospectively reviewed all patients with brain or spine lesions operated on from September 2021 to July 2022 in the Pediatric Neurosurgery Unit of Hôpital Femme Mère Enfant, Lyon, who had received 5 mg/kg of 10%. Surgery was performed using a YELLOW560 filter at crucial times. At the end of surgery, the first operator completed a questionnaire, including his opinion on whether SF had been useful in tumor resection, recorded as a binary variable. Post hoc, surgical images were reviewed using ImageJ, an open-source Java image processing platform. In order to compare independent discrete variables, we applied the Student’s t test, and we applied the Chi-square or Fisher exact test for binary variables. A threshold of p < 0.05 was set for statistical significance.

Results

We included 50 pediatric patients (0.2–17.6 years old). Forty/50 lesions showed SF uptake (80%). The differentiation between healthy and affected tissue, thanks to SF, subjectively evaluated by the surgeon, had as objective counterpart the statistically significant higher brightness of green in lesions, registered by the software (p < 0.001). SF overall allowed a good differentiation in 33/50 lesions, and overall utility of SF has been noted in 67% of them. When specifically considering gliomas, overall utility reached 75%.

Conclusion

SF is a feasible, safe, and useful intraoperative adjunct in pediatric neurosurgery. In particular, it seems to have a promising role in some low-grade infiltrating glial tumors. The subjective evaluation of fluorescence seems to be reliable with respect to image analyses software.

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Authors and Affiliations

  1. Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon, France

    Camilla de Laurentis, Fred Bteich, Pierre Aurélien Beuriat, Laryssa Crystinne Azevedo Almeida, Carmine Mottolese, Matthieu Vinchon, Alexandru Szathmari & Federico Di Rocco

  2. Université Claude Bernard Lyon I, Lyon, France

    Camilla de Laurentis, Fred Bteich, Pierre Aurélien Beuriat, Laryssa Crystinne Azevedo Almeida, Carmine Mottolese, Matthieu Vinchon, Alexandru Szathmari & Federico Di Rocco

  3. Department of Medicine and Surgery, Università Degli Studi Di Milano Bicocca, Milan, Italy

    Camilla de Laurentis

  4. Pediatric Anesthesiology, Hôpital Femme Mère Enfant, Lyon, France

    Sylvie Combet

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Contributions

Federico Di Rocco and Camilla de Laurentis contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Camilla de Laurentis; Federico Di Rocco, Matthieu Vinchon, and Alexandru Szathmari supervised the process. The first draft of the manuscript was written by Camilla de Laurentis and Federico Di Rocco, and all the authors (Fred Bteich, Pierre Aurélien Beuriat, Laryssa Crystinne Azevedo Almeida, Sylvie Combet, Carmine Mottolese, Matthieu Vinchon, Alexandru Szathmari) commented on previous versions of the manuscript. All the authors (Camilla de Laurentis, Fred Bteich, Pierre Aurélien Beuriat, Laryssa Crystinne Azevedo Almeida, Sylvie Combet, Carmine Mottolese, Matthieu Vinchon, Alexandru Szathmari, Federico Di Rocco) read and approved the final manuscript.

Corresponding author

Correspondence to Federico Di Rocco.

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Ethics approval and consent to participate

This retrospective study was submitted to and approved by our institutional ethics committee, IRB de Neurochirurgie, no. IRB00011687, Collège de Neurochirurgie IRB #1: 2022/46. Parental informed consent was obtained.

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Not applicable (anonymization of data).

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de Laurentis, C., Bteich, F., Beuriat, P.A. et al. Sodium fluorescein in pediatric oncological neurosurgery: a pilot study on 50 children. Childs Nerv Syst 39, 1473–1484 (2023). https://doi.org/10.1007/s00381-022-05765-4

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