Fluorescence-guided surgery of intraspinal tumors

Background:
lntraspinal tumors are rare and normally appear with contrast enhancement on MRI due to a damaged blood-brain barrier. The purpose of the two intraoperative videos is to show the advantages of fluorescein-guided resection of an intraspinal juxtamedullary thoracic meningioma and an intraspinal intramedullary cervical ependymoma WHO II.

Methods:
Two patients (two females, 65 and 84 years of age) received 5-10 mg/kg body weight administered intravenously shortly after anesthetization. Tumor removal was performed microsurgically with a midline dural incision under intraoperative neuromonitoring (MEPs, SSEPs) with a ZEISS KINEVO 900 microscope equipped with a YELLOW 560 filter.

Results:
Both tumors showed strong fluorescein enhancement, facilitating tumor visualization and resection by improving discrimination between tumor and healthy spinal cord and dura. Both tumors could be resected completely. In the intramedullary ependymoma, fluorescein was especially helpful after tumor removal to check for tumor remnants in the residual tumor cavity. In the meningioma, fluorescein optimized visualization and resection of the dural tail, which also showed strong fluorescence under the YELLOW filter. No adverse events occurred. Postoperative MRI and follow-up (3 and 30 months postop) imaging showed complete tumor removal in both patients without evidence of tumor recurrence.

Conclusion:
Fluorescein-guided resection of intraspinal tumors intra- and extramedullary can be performed safely and effectively by improving tumor visualization and resection.