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Sodium Fluorescein-Guided Microsurgery for Intramedullary Spinal Ependymomas: Technical Nuances, Surgical Workflow,
Silvia Michelini1, Amer A Alomari2, Flavia Fraschetti1
1Department of Neurosurgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy.
World Neurosurgery
|June 2, 2026
Summary
Sodium Fluorescein (SF) guided surgery shows promise for intramedullary ependymomas. This technique aids in visualizing the tumor-cord interface, achieving gross total resection and favorable early outcomes in a small patient cohort.
Area of Science:
- Neurosurgery
- Oncology
- Spinal Cord Surgery
Background:
- Intramedullary ependymomas are the most common spinal cord tumors.
- Microsurgical resection is the primary treatment, with outcomes linked to preoperative status and tumor resection extent.
- Intraoperative adjuncts like microscopy, ultrasound, and neurophysiological monitoring aid safe resection.
Purpose of the Study:
- To evaluate the utility of Sodium Fluorescein (SF) guided surgery for intramedullary spinal ependymomas.
- To describe the surgical workflow and technical nuances of SF-guided resection.
- To assess early neurological outcomes following SF-guided microsurgical resection.
Main Methods:
- A technical note describing a multimodal surgical strategy.
- Fluorescence-guided microsurgical resection using Sodium Fluorescein (SF) in five consecutive patients with WHO grade 2 intramedullary spinal ependymomas.
- Intraoperative fluorescence visualization of the tumor-cord interface.
Main Results:
- SF fluorescence was detectable in all five patients.
- Gross total resection was achieved in all cases.
- Early neurological outcomes were favorable across the cohort.
Conclusions:
- Sodium Fluorescein (SF) may serve as a valuable adjunct in the multimodal surgical management of intramedullary spinal ependymomas.
- SF facilitates intraoperative visualization, potentially improving tumor resection.
- Further prospective studies are warranted to solidify the role of SF in intramedullary tumor surgery.
