Abstract
Introduction Brainstem gliomas (BsG) account for 10 to 15% of pediatric brain tumors. Surgery
is the preferred treatment for focal and exophytic lesions. Sodium fluorescein has
been proven safe and effective in resection of malignant brain tumors.
Objective The objective was to o analyze the safety and effectiveness of this approach, to
evaluate intraoperative fluorescein imaging, and to measure the safety of chosen dose
for pediatric patients.
Methods Twelve cases were enrolled between March 2014 and September 2016 in Beijing Tiantan
Hospital. All of the patients received 2.5 mg/kg of sodium fluorescein before opening
the dura; the intraoperative fluorescence enhancement was observed, and the degree
of satisfaction and consistency with the neuronavigation were evaluated.
Results With a mean age of 7.5 years, there were eight cases located within the pontine,
three in the medullary oblongata, and one in the tectal plate. Histological results
were astrocytoma, glioblastoma, oligodendroglioma, and pilocytic astrocytoma. Under
the fluorescein module of the microscope, the tumors were recognizable enough to help
surgeons to discriminate the lesion from non-fluorescent tissue, with a consistency
of 83% with the neuronavigation. Total removal was accomplished in nine cases, while
the mean percentage of resection of the other cases was 93.7%. The Karnofsky performance
score (KPS) showed no significant differences between pre-operation and discharge,
but there was a difference between pre-operation and 6-month follow-up.
Conclusion The fluorescein-guided surgery is useful for demarcating the tumor margin and works
well with other navigation and monitoring devices. A safe dose of sodium fluorescein
(2.5 mg/kg) was proven effective for children.
Keywords
sodium fluorescein - pediatric brainstem gliomas - yellow 560 nm - surgery - safe
dose
