Enhancing Brain Metastasis Resection Rates with Sodium Fluorescein
Overview
This study evaluated the impact of sodium fluorescein (Na-Fl) on surgical resection of brain metastases (BM). Use of Na-Fl improved the accuracy of extent of resection (EOR) estimation and facilitated more complete tumor removal without increasing neurological complications.
Background
Brain metastases are the most common intracranial tumors and significantly affect patient quality of life. Surgical resection is a key treatment, especially for larger or limited numbers of BM, offering rapid symptom relief and prolonged survival. However, the extent of resection often differs between surgeon estimation and postoperative MRI findings. Sodium fluorescein, a fluorescent dye highlighting disrupted blood-brain barrier areas, has been introduced to enhance visualization of tumors during surgery, potentially improving resection completeness.
Data Highlights
Parameter
Value
Number of patients
79
Median age (years)
63 (IQR 54.5–71.5)
Fluorescein use
53 cases (67%)
Median preoperative KPS
90 (IQR 85–95)
Median preoperative tumor volume (cm³)
11.7 (IQR 4.3–19.1)
Expected gross total resection (GTR) by surgeons
95%
Key Findings
Sodium fluorescein enabled clearer delineation of brain metastases from surrounding tissue during surgery.
Use of fluorescein reduced the discrepancy between surgeons' estimated extent of resection and MRI-confirmed resection.
Fluorescein-guided surgery was associated with increased rates of complete tumor resection without increased postoperative neurological deficits.
Postoperative MRI within 48 hours was used to accurately assess residual tumor volume and extent of resection.
Fluorescein use did not negatively impact postoperative neurological outcomes or Karnofsky Performance Scores.
Clinical Implications
Incorporating sodium fluorescein in surgical resection of brain metastases can improve the surgeon's ability to achieve complete tumor removal while preserving neurological function. This technique may enhance patient outcomes by reducing residual tumor burden and potentially prolonging survival. Fluorescein-guided surgery should be considered as an adjunct in centers equipped with appropriate fluorescence-capable microscopes.
Conclusion
Sodium fluorescein is a valuable tool in fluorescence-guided resection of brain metastases, improving the accuracy of tumor removal and aligning surgical expectations with radiological outcomes without compromising patient safety.
References
Study Authors/Medical University of Innsbruck/2021 -- Bridging the Divide: Enhancing Brain Metastasis Resection Rates with Sodium Fluorescein Utilization
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