title: Fluorescein sodium-guided resection of cerebral metastases-an update.
abstract: Cerebral metastasis (CM) is the most common malignancy affecting the brain. In patients eligible for surgery, complete tumor removal is the most important predictor of overall survival and neurological outcome. The emergence of surgical microscopes fitted with a fluorescein-specific filter have facilitated fluorescein-guided microsurgery and identification of tumor tissue. In 2012, we started evaluating fluorescein (FL) with the dedicated microscope filter in cerebral metastases (CM). After describing the treatment results of our first 30 patients, we now retrospectively report on 95 patients.
  
  
  
  Ninety-five patients with CM of different primary cancers were included (47 women, 48 men, mean age, 60 years, range, 25-85 years); 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560-nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control. The extent of resection (EOR) was assessed by means of early postoperative contrast-enhanced MRI and the grade of fluorescent staining as described in the surgical reports. Furthermore, we evaluated information on neurological outcome and surgical complications as well as any adverse events.
  
  
  
  Ninety patients (95%) showed bright fluorescent staining that markedly enhanced tumor visibility. Five patients (5%); three with adenocarcinoma of the lung, one with melanoma of the skin, and one with renal cell carcinoma) showed insufficient FL staining. Thirteen patients (14%) showed residual tumor tissue on the postoperative MRI. Additionally, the MRI of three patients did not confirm complete resection beyond doubt. Thus, gross-total resection had been achieved in 83% (n = 79) of patients. No adverse events were registered during the postoperative course.
  
  
  
  FL and the YELLOW 560-nm filter are safe and feasible tools for increasing the EOR in patients with CM. Further prospective evaluation of the FL-guided technique in CM-surgery is in planning.
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany. julius.hoehne@ukr.de.|Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. julius.hoehne@ukr.de.
authors.forename: Julius
authors.identifier: 0000-0002-8238-2211
authors.initials: J
authors.lastname: Höhne
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.|Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hohenberger
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.|Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Proescholdt
authors.affiliation: Institute of Neuropathology, University Medical Center Regensburg, Regensburg, Germany.|Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Riemenschneider
authors.affiliation: Institute of Radiology, Neuroradiology Branch, University Medical Center Regensburg, Regensburg, Germany.|Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Wendl
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.|Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.|Wilhelm-Sander Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Schebesch
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008545:Melanoma / Q000473:pathology; D008875:Middle Aged; D018365:Neoplasm, Residual; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D015173:Supratentorial Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein
keywords: Cerebral metastases; Fluorescein sodium; Fluorescence-guided surgery; Neurosurgery; PENTERO 900; Surgical microscope; YELLOW 560-nm filter