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J Neurol Surg B Skull Base 2014; 75(04): 255-260
DOI: 10.1055/s-0034-1372466
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Skull Base Meningiomas and Cranial Nerves Contrast Using Sodium Fluorescein: A New Application of an Old Tool

Carlos Eduardo da Silva
1   Department of Neurosurgery and Skull Base Surgery, Instituto de Cirurgia da Base do Crânio, Hospital Ernesto Dornelles, Porto Alegre/RS, Brazil
,
Vinicius Duval da Silva
2   Department of Pathology and Radiation, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre/RS, Brazil
,
Jefferson Luis Braga da Silva
3   Service of Hand Surgery and Reconstructive Microsurgery, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre/RS, Brazil
› Author Affiliations
Further Information

Publication History

18 October 2013

23 December 2013

Publication Date:
17 April 2014 (online)

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Abstract

Objective The identification of cranial nerves is one of the most challenging goals in the dissection of skull base meningiomas. The authors present an application of sodium fluorescein (SF) in skull base meningiomas with the purpose of improving the identification of cranial nerves.

Design A prospective study within-subjects design.

Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil.

Participants Patients with skull base meningiomas.

Main Outcomes Measures Cranial nerve identification.

Results The group of nine meningiomas was composed of one cavernous sinus, three petroclival, one tuberculum sellae, two sphenoid wing, one olfactory groove, and one temporal floor meningioma. The SF enhancement in all tumors was strong, and the contrast with cranial nerves clearly evident. There were one definite olfactory nerve deficit, one transient abducens deficit, and one definite hemiparesis. All lesions were resected (Simpson grades 1 and 2). The analysis of the difference of the delta SF wavelength between the meningiomas and cranial nerve contrast was performed by the Wilcoxon signed rank test and showed p = 0.011.

Conclusions The contrast between the enhanced meningiomas and cranial nerves was evident and assisted in the visualization and microsurgical dissection of these structures. The anatomical preservation of these structures was improved using the contrast.

Keywords

cranial nerves - fluorescent markers - fluorescent-guided surgery - meningiomas - sodium fluorescein
 

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