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Verly G, Delfino T, Oliveira LDB, Batista S, Sousa MP, Schevz R, Ferreira MY, Bertani R. A light in the darkness: sodium fluorescein-assisted peripheral nerve sheath tumors resection - a comprehensive systematic review and single-arm meta-analysis. Neurosurg Rev 2024; 47:181. [PMID: 38649501 DOI: 10.1007/s10143-024-02414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/13/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
The treatment for peripheral nerve sheath tumors (PNSTs) is based on surgical excision and the primary goal is to improve symptoms whilst preserving neurological function. In order to improve this technique, surgeons may use sodium fluorescein (SF) to help visualize the neoplasm and, consequently, facilitate its removal. Aiming to assess the efficacy of this emerging surgical strategy, we conducted a systematic review and single-arm meta-analysis. We conducted a systematic search on the PubMed, Embase, and Web of Science databases, following the PRISMA guidelines. Studies without outcomes of interest, case series with less than four patients, letters, comments, technical notes, editorials, reviews, and basic research papers were excluded. The outcomes considered for this study were: the number of tumors that achieved total resection, subtotal resection, or near total resection, the approach/technique utilized by the surgeon, SF-related complications, and total complications. Five studies, with a total of 175 individuals, were included in our survey. Notably, 70% of the neoplasms presented by the patients were schwannomas. Considering extracranial lesions, we found a proportion of 96% (95% CI: 88 - 100%) in total resection, 0% (95% CI: 0-1%) in near total resection, and 4% (95% CI: 0-12%) in subtotal resection, all linked to an amount of 185 analyzed PNSTs. Furthermore, a proportion of 1% (95% CI: 0 - 2%) in SF-related complications was spotted among 183 patients. Finally, total complications analysis accounted for 11% (95% CI: 0 - 25%) among 183 individuals. We concluded that SF-assisted resection of PNSTs is a suitable and relatively safe technique, linked to minimum complications, of which the majority was not associated with the chemical compound itself. Future research is necessary to increase the number of patients available in the current literature and, therefore, enhance future analyses.
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Affiliation(s)
- Gabriel Verly
- Faculty of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-617, Brazil
| | - Thiffany Delfino
- Faculty of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-617, Brazil
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-617, Brazil
| | - Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-617, Brazil.
| | - Rodrigo Schevz
- Faculty of Medicine, Faculty of Medicine of ABC, Santo André, SP, Brazil
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
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Nazzi V, Innocenti N, Castelli N, Tramacere I, Eoli M, Cojazzi V, Gatti L, Acerbi F, Falco J, Vetrano IG. Assessing the role of sodium fluorescein in peripheral nerve sheath tumors and mimicking lesions surgery: An update after 142 cases. Front Oncol 2023; 12:1070878. [PMID: 36698394 PMCID: PMC9868923 DOI: 10.3389/fonc.2022.1070878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Peripheral nerve sheath tumors (PNST) include mainly schwannomas and neurofibromas. Surgical resection represents the mainstay of treatment but due to their pathogenesis, distinguishing between intact functional nerve and the fibers from whence the PNST arose may not always be easy to perform, constituting the most relevant risk factor in determining a worsening in neurological condition. The introduction of intraoperative tools to better visualize these tumors could help achieve a gross-total resection. In this study, we analyzed the effect of sodium fluorescein (SF) on the visualization and resection of a large cohort of PNST. Methods Between September 2018 and December 2021, 142 consecutive patients harboring a suspected PNST underwent fluorescein-guided surgery at the Department of Neurosurgery of the Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. All patients presented with a different degree of contrast enhancement at preoperative MRI. SF was intravenously injected after intubation at 1 mg/kg. Intraoperative fluorescein characteristics and postoperative neurological and radiological outcomes were collected, analyzed, and retrospectively compared with a historical series. Results 142 patients were included (42 syndromic and 100 sporadic); schwannoma was the predominant histology, followed by neurofibroma (17 neurofibroma e 12 plexiform neurofibroma) and MPNST. Bright fluorescence was present in all cases of schwannomas and neurofibromas, although with a less homogeneous pattern, whereas it was significantly less evident for malignant PNST; perineurioma and hybrid nerve sheath tumors were characterized by a faint fluorescence enhancement. The surgical resection rate in the general population and even among the subgroups was about 66.7%; from the comparative analysis, we found a consistently higher rate of complete tumor removal in plexiform neurofibromas, 66% in the "fluorescent" group vs 44% in the "historical" group (p-value < 0.05). The rate of complications and mean surgical time were superimposable among the two populations. Conclusions SF is a valuable method for safe fluorescence-guided PNST and mimicking lesions resection. Our data showed a positive effect of fluorescein-guided surgery in increasing the rate of surgical resection of plexiform neurofibromas, suggesting a possible role in improving the functional and oncological outcome of these lesions.
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Affiliation(s)
- Vittoria Nazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Niccolò Innocenti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nicolò Castelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marica Eoli
- Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Cojazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Gatti
- Neurobiology Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,Neurobiology Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy,*Correspondence: Ignazio G. Vetrano,
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6
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Dengler NF, Scholz C, Beck J, Uerschels AK, Sure U, Scheller C, Strauss C, Martin D, Schackert G, Heinen C, Woitzik J, McLean AL, Rosahl SK, Kolbenschlag J, Heinzel J, Schuhmann M, Tatagiba MS, Guerra WKW, Schroeder HWS, Vetrano IG, Ahmadi R, Unterberg A, Reinsch J, Zdunczyk A, Unteroberdoerster M, Vajkoczy P, Wehner S, Becker M, Matthies C, Pérez-Tejón J, Dubuisson A, Barrone DG, Trivedi R, Capone C, Ferraresi S, Kraschl J, Kretschmer T, Dombert T, Staub F, Ronellenfitsch M, Marquardt G, Prinz V, Czabanka M, Carolus A, Braun V, König R, Antoniadis G, Wirtz CR, Rasulic L, Pedro MT. Rationale and design of the peripheral nerve tumor registry: an observational cohort study. Neurol Res 2023; 45:81-85. [PMID: 36208460 DOI: 10.1080/01616412.2022.2129762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM Peripheral nerve tumors (PNT) are rare lesions. To date, no systematic multicenter studies on epidemiology, clinical symptoms, treatment strategies and outcomes, genetic and histopathologic features, as well as imaging characteristics of PNT were published. The main goal of our PNT Registry is the systematic multicenter investigation to improve our understanding of PNT and to assist future interventional studies in establishing hypotheses, determining potential endpoints, and assessing treatment efficacy. METHODS Aims of the PNT registry were set at the 2015 Meeting of the Section of Peripheral Nerve Surgery of the German Society of Neurosurgery. A study protocol was developed by specialists in PNT care. A minimal data set on clinical status, treatment types and outcomes is reported by each participating center at initial contact with the patient and after 1 year, 2 years, and 5 years. Since the study is coordinated by the Charité Berlin, the PNR Registry was approved by the Charité ethics committee (EA4/058/17) and registered with the German Trials Registry (www.drks.de). On a national level, patient inclusion began in June 2016. The registry was rolled out across Europe at the 2019 meeting of the European Association of Neurosurgery in Dublin. RESULTS Patient recruitment has been initiated at 10 centers throughout Europe and 14 additional centers are currently applying for local ethics approval. CONCLUSION To date, the PNT registry has grown into an international study group with regular scientific and clinical exchange awaiting the first results of the retrospective study arm.
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Affiliation(s)
- Nora F Dengler
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Christoph Scholz
- Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg i.B, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg i.B, Germany
| | - Anne-Kathrin Uerschels
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ullrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christian Scheller
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, University of Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - Daniel Martin
- Department of Neurosurgery, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christian Heinen
- Department of Neurosurgery, Evangelisches Krankenhaus, Carl von Ossietzky University Oldenburg, Marienstr. 11, 26121 Oldenburg, Germany.,Department of Neurosurgery, PeripheralNerveUnit Nord, Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Evangelisches Krankenhaus, Carl von Ossietzky University Oldenburg, Marienstr. 11, 26121 Oldenburg, Germany
| | - Anna Lawson McLean
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Steffen K Rosahl
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive, and Burn Surgery, BG Klinik Tübingen, Schnarrenbergstraße 95, 72076 Tübingen Germany
| | - Johannes Heinzel
- Department of Hand-, Plastic, Reconstructive, and Burn Surgery, BG Klinik Tübingen, Schnarrenbergstraße 95, 72076 Tübingen Germany
| | - Martin Schuhmann
- Department of Neurosurgery, Universitätsklinikum Tübingen, Hippe-Seyler-Straße 3, 72076 Tübingen Germany
| | - Marco Soares Tatagiba
- Department of Neurosurgery, Universitätsklinikum Tübingen, Hippe-Seyler-Straße 3, 72076 Tübingen Germany
| | | | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Sauerbruchstr. 1, 17475 Greifswald, Germany
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione I.R.C.C.S Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133 Milano, Italy
| | - Rezvan Ahmadi
- Department of Neurosurgery, Heidelberg University Hospital, Berlin, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Berlin, Germany
| | - Jennifer Reinsch
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Zdunczyk
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Meike Unteroberdoerster
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sarah Wehner
- Department of Plastic, Reconstructive, and Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Becker
- Department of Plastic, Reconstructive, and Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Cordula Matthies
- Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany
| | - Jose Pérez-Tejón
- Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany
| | - Annie Dubuisson
- Department of Neurosurgery, CHU Liège, Avenue de L'Hôpital 1, Liège, Belgium
| | - Damiano G Barrone
- Department of Clinical Neurosciences, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Rikin Trivedi
- Department of Clinical Neurosciences, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Crescenzo Capone
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University Napoli "Frederico II", Naples, Italy
| | - Stefano Ferraresi
- Department of Neurosurgery, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Jakob Kraschl
- Department of Neurosurgery and Neurorestoration, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Thomas Kretschmer
- Department of Neurosurgery and Neurorestoration, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | | | - Frank Staub
- Center for Peripheral Neurosurgery, Dossenheim, Germany
| | - Michael Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg, Frankfurt am Main, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Siegen, Germany
| | - Vincent Prinz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Siegen, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Siegen, Germany
| | - Anne Carolus
- Department of Neurosurgery, Diakonie Klinikum Jung-Stilling-Krankenhaus Neurochriurgische Klinik, Siegen, Germany
| | - Veit Braun
- Department of Neurosurgery, Diakonie Klinikum Jung-Stilling-Krankenhaus Neurochriurgische Klinik, Siegen, Germany
| | - Ralph König
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
| | - Gregor Antoniadis
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
| | - Christian Rainer Wirtz
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
| | - Lukas Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Maria Teresa Pedro
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Ulm University, District Hospital, Günzburg, Germany
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