Fluorescein-Guided Surgery for Pediatric Brainstem Gliomas: Preliminary Study and Technical Notes

Area of Science:

• Neurosurgery
• Pediatric Oncology
• Medical Imaging

Background:

• Brainstem gliomas (BsG) represent 10-15% of pediatric brain tumors.
• Surgical resection is the primary treatment for focal and exophytic BsG.
• Sodium fluorescein is a validated agent for enhancing malignant brain tumor resection.

Purpose of the Study:

• To assess the safety and efficacy of sodium fluorescein for pediatric brainstem glioma resection.
• To evaluate intraoperative fluorescein imaging for tumor demarcation.
• To determine the safety of a 2.5 mg/kg sodium fluorescein dose in pediatric patients.

Main Methods:

• A prospective study of 12 pediatric patients with brainstem gliomas.
• Administration of 2.5 mg/kg sodium fluorescein prior to dural opening.
• Intraoperative observation of fluorescence enhancement and comparison with neuronavigation.

Main Results:

• Tumors were clearly visualized under fluorescein, aiding discrimination from healthy tissue (83% consistency with neuronavigation).
• Complete tumor resection was achieved in 9 cases; mean resection for others was 93.7%.
• No significant change in Karnofsky Performance Score (KPS) from pre-operation to discharge; a difference was noted at 6-month follow-up.

Conclusions:

• Fluorescein-guided surgery effectively demarcates tumor margins in pediatric brainstem gliomas.
• The 2.5 mg/kg dose of sodium fluorescein is safe and effective for pediatric use.
• This technique integrates well with existing navigation and monitoring systems for improved surgical outcomes.