144 Use of Intraoperative Sodium Fluorescein During Nerve Tumor Surgery: A Systematic Review

Abstract

INTRODUCTION: Nerve tumors are categorized into various classifications based on location, origin, and malignant potential. Symptoms and signs of nerve tumors result from direct infiltration of the nerve, compression on adjacent tissues, or the mass effect of the tumor. The primary treatment approach for nerve tumors is complete surgical resection. This should be achieved while preserving the function of the nerve. Sodium fluorescein holds promise in achieving this objective. METHODS: PubMed, EMBASE, Web-of-Science, and SCOPUS were searched to include studies reporting the use of sodium fluorescein in nerve tumors surgery. Intervention-related outcomes were systematically reviewed following the PRISMA guidelines. RESULTS: Our review comprised 5 studies encompassing 177 patients with a total of 179 tumors. Of these patients, 98 (55.4%) were female, and 101 (69.1%) had sporadic (non-syndromic) tumors. Histopathological examination revealed that 125 (69.8%) tumors were schwannoma WHO grade 1. No post-operative complications were reported in 149 (88.7%) patients. Gross total resection was achieved in 152 (84.9%) tumors. High tumor fluorescence was reported in 150 (94.3%) tumors, while absent and low parent nerve fluorescence was reported in 121 (79.6%) and 27 (17.8%) tumors, respectively. No side effects of the fluorescent dye were reported among the 179 tumor cases. The median latency period was 30 (range: 7-95) minutes, and the median duration of surgery was 51.5 (range: 24-92) minutes. CONCLUSIONS: Intraoperative sodium fluorescein shows promise as an aid in nerve tumor surgery, facilitating differentiation between the tumor, parent nerve, and surrounding soft tissue. Future prospective studies are necessary to determine its effect on surgical duration, postoperative complication rates, and extent of resection in comparison to current standard of care.