The use of the YELLOW 560 nm surgical microscope filter for sodium fluorescein-guided resection of brain tumors: Our preliminary results in a series of 28 patients

• Na-Fl accumulates in tumoral tissues via disrupted blood-brain barrier.
• Na-Fl is used to increase the extent of resection in brain tumor surgery.
• The cost of the drug is relatively low compared to 5-ALA.
• Na-Fl guidance with the use of a YELLOW 560 filter is safe and effective.

ObjectiveSodium fluorescein (Na-Fl) is a fluorescent dye that accumulates in tumoral tissues via disrupted blood-brain barrier. It has been used in fluorescence-guided surgery for various brain tumors. Herein, we report our initial experience and preliminary results for the first 28 patients who were operated on under Na-Fl guidance with the use of a special filter on the surgical microscope.Patient and methodsBetween January and November 2015, 200 mg (2–4 mg/kg) of Na-Fl was administered in 28 patients (30 surgeries) after anesthesia induction. The clinical features, surgical observations, extent of resection on the postoperative magnetic resonance imaging (MRI) and histopathology of the tumors were retrospectively analyzed. The use of YELLOW 560 nm filter was found “helpful” if the discrimination of the pinkish brain tissue and bright yellow stained tumor tissue was clear. Otherwise, it was described as “not helpful.ResultsThere were 23 high-grade and 7 metastatic tumors in our study group. Na-Fl was found helpful by means of the tumor demarcation in 29 of 30 operations (97%). In 23 of these 29 operations (79%), a total resection was achieved regardless of the tumor pathology. No adverse events were encountered regarding the use of Na-Fl.ConclusionNa-Fl guidance with the use of a YELLOW 560 filter is safe and effective in high-grade glioma and metastatic tumor surgery. We think it is feasible for increasing the extent of resection in these tumors.