Hybrid fluorescein-guided surgery for pituitary adenoma resection: a pilot study

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  • Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico

OBJECTIVE

The authors conducted a pilot study on hybrid fluorescein-guided surgery for pituitary adenoma resection and herein describe the feasibility and safety of this technique.

METHODS

In this pilot study, the authors included all consecutive patients presenting with pituitary adenomas, functioning and nonfunctioning. They performed a hybrid fluorescein-guided surgical technique for tumor resection. An endonasal endoscopic approach was used; after exposure of the rostrum of the sphenoid sinus, they administered a bolus of 8 mg/kg of fluorescein sodium (FNa) intravenously, and during resection, they alternated between endoscopic and microscopic techniques to guide the resection under a YELLOW 560 filter.

RESULTS

The study included 15 patients, 7 men (47%) and 8 women (53%). Of the pituitary adenomas, 7 (46%) were nonfunctioning, 6 (40%) were GH secreting, 1 (7%) was prolactin secreting, and 1 (7%) was ACTH secreting. There were no FNa-related complications (anaphylactic reactions); yellowish staining of urine, skin, and mucosa was seen in all patients and resolved in a maximum time of 24 hours. After color spectrophotometric analysis, the authors identified a statistical difference in fluorescence among tumor, gland, and scar tissue (p = 0.01).

CONCLUSIONS

This is the first study of its kind to describe the feasibility and safety of using FNa to guide the resection of pituitary adenomas. The authors found this technique to be safe and feasible. It may be used to obtain better surgical results, especially for hormone-producing and recurring tumors, as well as for reducing the learning curve in pituitary adenoma surgery.

ABBREVIATIONS FNa = fluorescein sodium; PA = pituitary adenoma.

Contributor Notes

Correspondence Juan Luis Gómez-Amador: Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico. jlga@neurocirugia-innn.com.

INCLUDE WHEN CITING Published online April 5, 2019; DOI: 10.3171/2019.1.JNS181512.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Acerbi F, Broggi M, Eoli M, Anghileri E, Cavallo C, Boffano C, : Is fluorescein-guided technique able to help in resection of high-grade gliomas? Neurosurg Focus 36(2):E5, 2014

    • Search Google Scholar
    • Export Citation
  • 2

    Akçakaya MO, Göker B, Kasımcan , Hamamcıoğlu MK, Kırış T: Use of sodium fluorescein in meningioma surgery performed under the YELLOW-560 nm surgical microscope filter: feasibility and preliminary results. World Neurosurg 107:966973, 2017

    • Search Google Scholar
    • Export Citation
  • 3

    da Silva CE, da Silva JL, da Silva VD: Use of sodium fluorescein in skull base tumors. Surg Neurol Int 1:70, 2010

  • 4

    da Silva CE, da Silva VD, da Silva JLB: Skull base meningiomas and cranial nerves contrast using sodium fluorescein: a new application of an old tool. J Neurol Surg B Skull Base 75:255260, 2014

    • Search Google Scholar
    • Export Citation
  • 5

    Diaz RJ, Dios RR, Hattab EM, Burrell K, Rakopoulos P, Sabha N, : Study of the biodistribution of fluorescein in glioma-infiltrated mouse brain and histopathological correlation of intraoperative findings in high-grade gliomas resected under fluorescein fluorescence guidance. J Neurosurg 122:13601369, 2015

    • Search Google Scholar
    • Export Citation
  • 6

    Dilek O, Ihsan A, Tulay H: Anaphylactic reaction after fluorescein sodium administration during intracranial surgery. J Clin Neurosci 18:430431, 2011

    • Search Google Scholar
    • Export Citation
  • 7

    Esquenazi Y, Essayed WI, Singh H, Mauer E, Ahmed M, Christos PJ, : Endoscopic endonasal versus microscopic transsphenoidal surgery for recurrent and/or residual pituitary adenomas. World Neurosurg 101:186195, 2017

    • Search Google Scholar
    • Export Citation
  • 8

    Hashimoto K, Kinouchi H, Yoshioka H, Kanemaru K, Ogiwara M, Yagi T, : Efficacy of endoscopic fluorescein video angiography in aneurysm surgery—novel and innovative assessment of vascular blood flow in the dead angles of the microscope. Oper Neurosurg (Hagerstown) 13:471481, 2017

    • Search Google Scholar
    • Export Citation
  • 9

    Jha SN: Colour measurements and modeling, in Jha SN (ed): Nondestructive Evaluation of Food Quality. Theory and Practice. Berlin: Springer-Verlag, 2010, pp 1740

    • Search Google Scholar
    • Export Citation
  • 10

    Kakucs C, Florian IA, Ungureanu G, Florian IS: Fluorescein angiography in intracranial aneurysm surgery: a helpful method to evaluate the security of clipping and observe blood flow. World Neurosurg 105:406411, 2017

    • Search Google Scholar
    • Export Citation
  • 11

    Kuroiwa T, Kajimoto Y, Ohta T: Development of a fluorescein operative microscope for use during malignant glioma surgery: a technical note and preliminary report. Surg Neurol 50:4149, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Lane BC, Cohen-Gadol AA: A prospective study of microscope-integrated intraoperative fluorescein videoangiography during arteriovenous malformation surgery: preliminary results. Neurosurg Focus 36(2):E15, 2014

    • Search Google Scholar
    • Export Citation
  • 13

    Larkin S, Ansorge O: Pathology and pathogenesis of pituitary adenomas and other sellar lesions, in De Groot LJ, Chrousos G, Dungan K, (eds): Endotext. South Dartmouth, MA: MDText.com, Inc. (https://www.ncbi.nlm.nih.gov/books/NBK425704/) [Accessed January 21, 2019]

    • Search Google Scholar
    • Export Citation
  • 14

    Matano F, Mizunari T, Murai Y, Kubota A, Fujiki Y, Kobayashi S, : Quantitative comparison of the intraoperative utility of indocyanine green and fluorescein videoangiographies in cerebrovascular surgery. Oper Neurosurg (Hagerstown) 13:361366, 2017

    • Search Google Scholar
    • Export Citation
  • 15

    Molitch ME: Diagnosis and treatment of pituitary adenomas: a review. JAMA 317:516524, 2017

  • 16

    Molitch ME: Nonfunctioning pituitary tumors and pituitary incidentalomas. Endocrinol Metab Clin North Am 37:151171, xi, 2008

  • 17

    Okuda T, Kataoka K, Yabuuchi T, Yugami H, Kato A: Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium. J Clin Neurosci 17:118121, 2010

    • Search Google Scholar
    • Export Citation
  • 18

    Prete A, Corsello SM, Salvatori R: Current best practice in the management of patients after pituitary surgery. Ther Adv Endocrinol Metab 8:3348, 2017

    • Search Google Scholar
    • Export Citation
  • 19

    Rey-Dios R, Cohen-Gadol AA: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. Acta Neurochir (Wien) 155:701706, 2013

    • Search Google Scholar
    • Export Citation
  • 20

    Schebesch KM, Brawanski A, Hohenberger C, Höhne J: Fluorescein sodium-guided surgery of malignant brain tumors: history, current concepts, and future project. Turk Neurosurg 26:185194, 2016

    • Search Google Scholar
    • Export Citation
  • 21

    Schebesch KM, Hoehne J, Hohenberger C, Proescholdt M, Riemenschneider MJ, Wendl C, : Fluorescein sodium-guided resection of cerebral metastases—experience with the first 30 patients. Acta Neurochir (Wien) 157:899904, 2015

    • Search Google Scholar
    • Export Citation
  • 22

    Schebesch KM, Proescholdt M, Höhne J, Hohenberger C, Hansen E, Riemenschneider MJ, : Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery—a feasibility study. Acta Neurochir (Wien) 155:693699, 2013

    • Search Google Scholar
    • Export Citation
  • 23

    Tanahashi S, Lida H, Dohi S: An anaphylactoid reaction after administration of fluorescein sodium during neurosurgery. Anesth Analg 103:503, 2006

    • Search Google Scholar
    • Export Citation
  • 24

    Vaughan TB, Blevins LS, Vaphiades MS, Wand GS: Multimodal assessment of pituitary and parasellar lesions, in Quiñones-Hinojosa A (ed): Schmidek & Sweet: Operative Neurosurgical Techniques. Indications, Methods and Results, ed 6. Philadelphia: Elsevier Saunders, 2010, pp 192202

    • Search Google Scholar
    • Export Citation

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