Abstract：
OBJECTIVE: Complete surgical resection is still the mainstay in the treatment of central nervous system low-grade tumors, eventually resulting curative. The complete surgical removal of these lesions, however, may be difficult in some cases because of their infiltrative nature. Intraoperative adjuncts may be a game changer. Sodium fluorescein (SF) is among the ideal candidates as intraoperative tools to favor the actual recognition of the tumor extension, since it accumulates in areas of altered blood-brain barrier, a typical characteristic of pediatric gliomas, and has a low rate of adverse events. This work proposes an update of previous works about the evaluation of the feasibility and usefulness of a systematic use of SF in a low-grade lesion group of pediatric patients.
METHODS: Pediatric patients operated on for a resection or a biopsy of a low-grade glial or glioneuronal lesion (WHO grade I and II) at our Institution between September 2021 and December 2023, with the intraoperative use of sodium fluorescein (SF), were enrolled in the study. We collected pre-operative and postoperative clinical and radiological data, intraoperative findings, and post-operative pathological diagnoses.
RESULTS: No adverse events were registered related to the intraoperative use of SF. SF appeared useful for the localization of boundaries of tumors, especially when characterized by a high degree of infiltration or by a deep-seated location, and for the checking of possible tumor remnants at the end of surgery. A good tumor-to-healthy tissue contrast was registered when tumor visualization was in a range between 1 to 2 h and 30 min after SF injection. Possible \"false positives\" due to intraoperative vascular wall injury and clearance of SF from both tumor and healthy tissue were observed in some cases and still remain open issues.
CONCLUSIONS: SF is a feasible and safe intraoperative adjunct tool in the surgical removal of pediatric low-grade tumors. SF may show its usefulness especially in selected cases, such as deep-seated lesions and infiltrating tumors. Its safety profile, user-friendly management, and potential utility in both tumor resections and neuronavigated biopsies favor its wider use in the surgical treatment of pediatric low-grade tumors.
METHODS: Pediatric patients operated on for a resection or a biopsy of a low-grade glial or glioneuronal lesion (WHO grade I and II) at our Institution between September 2021 and December 2023, with the intraoperative use of sodium fluorescein (SF), were enrolled in the study. We collected pre-operative and postoperative clinical and radiological data, intraoperative findings, and post-operative pathological diagnoses.
RESULTS: No adverse events were registered related to the intraoperative use of SF. SF appeared useful for the localization of boundaries of tumors, especially when characterized by a high degree of infiltration or by a deep-seated location, and for the checking of possible tumor remnants at the end of surgery. A good tumor-to-healthy tissue contrast was registered when tumor visualization was in a range between 1 to 2 h and 30 min after SF injection. Possible \"false positives\" due to intraoperative vascular wall injury and clearance of SF from both tumor and healthy tissue were observed in some cases and still remain open issues.
CONCLUSIONS: SF is a feasible and safe intraoperative adjunct tool in the surgical removal of pediatric low-grade tumors. SF may show its usefulness especially in selected cases, such as deep-seated lesions and infiltrating tumors. Its safety profile, user-friendly management, and potential utility in both tumor resections and neuronavigated biopsies favor its wider use in the surgical treatment of pediatric low-grade tumors.
摘要：
目的：完整的手术切除仍是治疗中枢神经系统低度肿瘤的主要方法。最终导致治愈。这些病变的完全手术切除，然而,在某些情况下可能会很困难，因为它们具有渗透性。手术中的辅助可能会改变游戏规则。荧光素钠（SF）是理想的候选人作为术中工具，有利于肿瘤扩展的实际识别，因为它积聚在血脑屏障改变的区域，小儿神经胶质瘤的典型特征，不良事件发生率低。这项工作提出了对先前有关在低度病变组儿科患者中系统地使用SF的可行性和实用性评估的工作的更新。
方法：在2021年9月至2023年12月期间，在我们的研究所进行低级别神经胶质或神经胶质神经元病变（WHOI级和II级）切除或活检的儿科患者，术中使用荧光素钠（SF），参加了这项研究。我们收集了术前和术后的临床和放射学数据，术中发现,术后病理诊断。
结果：未发现与术中使用SF相关的不良事件。SF似乎对肿瘤边界的定位有用，尤其是以高度渗透或深层位置为特征时，以及在手术结束时检查可能的肿瘤残留物。当肿瘤可视化在SF注射后1至2小时至30分钟的范围内时，可以记录良好的肿瘤与健康组织对比。在某些情况下，观察到由于术中血管壁损伤和SF从肿瘤和健康组织中清除而导致的可能的“假阳性”，但仍然存在问题。
结论：SF是手术切除小儿低度肿瘤的一种可行且安全的术中辅助工具。SF可能会显示其有用性，特别是在选定的情况下，如深层病变和浸润性肿瘤。它的安全特征，用户友好的管理，在肿瘤切除和神经活检中的潜在实用性有利于其在小儿低度肿瘤的外科治疗中的更广泛使用。
方法：在2021年9月至2023年12月期间，在我们的研究所进行低级别神经胶质或神经胶质神经元病变（WHOI级和II级）切除或活检的儿科患者，术中使用荧光素钠（SF），参加了这项研究。我们收集了术前和术后的临床和放射学数据，术中发现,术后病理诊断。
结果：未发现与术中使用SF相关的不良事件。SF似乎对肿瘤边界的定位有用，尤其是以高度渗透或深层位置为特征时，以及在手术结束时检查可能的肿瘤残留物。当肿瘤可视化在SF注射后1至2小时至30分钟的范围内时，可以记录良好的肿瘤与健康组织对比。在某些情况下，观察到由于术中血管壁损伤和SF从肿瘤和健康组织中清除而导致的可能的“假阳性”，但仍然存在问题。
结论：SF是手术切除小儿低度肿瘤的一种可行且安全的术中辅助工具。SF可能会显示其有用性，特别是在选定的情况下，如深层病变和浸润性肿瘤。它的安全特征，用户友好的管理，在肿瘤切除和神经活检中的潜在实用性有利于其在小儿低度肿瘤的外科治疗中的更广泛使用。
