title: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module.
abstract: BACKGROUND
  Fluorescent technology has recently become a valuable tool in the surgical management of neoplastic and vascular lesions. The availability of microscope-integrated fluorescent modules has facilitated incorporation of this technology within the microsurgical workflow. The currently available microscope integrated modules use 5-aminolevulinic acid (5-ALA) and indocyanine green (ICG) as fluorophores.
  
  
  METHODS
  Fluorescein sodium is a fluorescent molecule that has been used specifically in ophthalmology for the treatment of retinal angiography. A new microscope-integrated fluorescent module has been recently developed for fluorescein. We employed this technology to maximize resection of tumors and perform intraoperative angiography to guide microsurgical management of aneurysms and arteriovenous malformations.
  
  
  RESULTS
  Fluorescein fluorescence allows the surgeon to appreciate fluorescent structures through the oculars while visualizing non-fluorescent tissues in near natural colors. Therefore, the operator can proceed with microsurgery under the fluorescent mode. We present three representative cases in which the use of fluorescein fluorescence was found useful in the surgeon's decision making during surgery.
  
  
  CONCLUSIONS
  The applications of this new microscope-integrated fluorescent module are multiple, and include vascular and oncologic neurosurgery. Further clinical investigations with large patient cohorts are needed to fully establish the role of this new technology.
authors: Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA. rrey-dios@umc.edu
authors: Roberto
authors: R
authors: Rey-Dios
authors: Aaron A
authors: AA
authors: Cohen-Gadol
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D019793:Fluorescein; D005451:Fluorescein Angiography / Q000379:methods; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008856:Microscopy, Fluorescence; D008866:Microsurgery / Q000379:methods*; D019635:Neurosurgical Procedures
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green; D019793:Fluorescein