Skull Base Meningiomas and Cranial Nerves Contrast Using Sodium Fluorescein: A New Application of an Old Tool

 

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Abstract

Objective The identification of cranial nerves is one of the most challenging goals in the dissection of skull base meningiomas. The authors present an application of sodium fluorescein (SF) in skull base meningiomas with the purpose of improving the identification of cranial nerves.

Design A prospective study within-subjects design.

Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil.

Participants Patients with skull base meningiomas.

Main Outcomes Measures Cranial nerve identification.

Results The group of nine meningiomas was composed of one cavernous sinus, three petroclival, one tuberculum sellae, two sphenoid wing, one olfactory groove, and one temporal floor meningioma. The SF enhancement in all tumors was strong, and the contrast with cranial nerves clearly evident. There were one definite olfactory nerve deficit, one transient abducens deficit, and one definite hemiparesis. All lesions were resected (Simpson grades 1 and 2). The analysis of the difference of the delta SF wavelength between the meningiomas and cranial nerve contrast was performed by the Wilcoxon signed rank test and showed p = 0.011.

Conclusions The contrast between the enhanced meningiomas and cranial nerves was evident and assisted in the visualization and microsurgical dissection of these structures. The anatomical preservation of these structures was improved using the contrast.

• References

• 1 Moore GE, Peyton WT, French LA, Walker WW. The clinical use of fluorescein in neurosurgery; the localization of brain tumors. J Neurosurg 1948; 5 (4) 392-398
  CrossrefPubMedGoogle Scholar
• 2 Kuroiwa T, Kajimoto Y, Ohta T. Development of a fluorescein operative microscope for use during malignant glioma surgery: a technical note and preliminary report. Surg Neurol 1998; 50 (1) 41-48; discussion 48–49
  CrossrefPubMedGoogle Scholar
• 3 Kuroiwa T, Kajimoto Y, Ohta T. Comparison between operative findings on malignant glioma by a fluorescein surgical microscopy and histological findings. Neurol Res 1999; 21 (1) 130-134
  PubMedGoogle Scholar
• 4 Shinoda J, Yano H, Yoshimura S , et al. Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note. J Neurosurg 2003; 99 (3) 597-603
  CrossrefPubMedGoogle Scholar
• 5 Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ. Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg 2000; 93 (6) 1003-1013
  CrossrefPubMedGoogle Scholar
• 6 Okuda T, Kataoka K, Taneda M. Metastatic brain tumor surgery using fluorescein sodium: technical note. Minim Invasive Neurosurg 2007; 50 (6) 382-384
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 da Silva CE, da Silva JLB, da Silva VD. Use of sodium fluorescein in skull base tumors. Surg Neurol Int 2010; 1: 70
  CrossrefPubMedGoogle Scholar
• 8 Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery 1987; 21 (4) 474-477
  CrossrefPubMedGoogle Scholar
• 9 al-Mefty O, Anand VK. Zygomatic approach to skull-base lesions. J Neurosurg 1990; 73 (5) 668-673
  CrossrefPubMedGoogle Scholar
• 10 Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery 1988; 22 (3) 510-517
  CrossrefPubMedGoogle Scholar
• 11 Ammirati M, Samii M. Presigmoid sinus approach to petroclival meningiomas. Skull Base Surg 1992; 2 (3) 124-128
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Cusimano MD, Sekhar LN, Sen CN , et al. The results of surgery for benign tumors of the cavernous sinus. Neurosurgery 1995; 37 (1) 1-9; discussion 9–10
  CrossrefPubMedGoogle Scholar
• 13 Day JD. Cranial base surgical techniques for large sphenocavernous meningiomas: technical note. Neurosurgery 2000; 46 (3) 754-759; discussion 759–760
  CrossrefPubMedGoogle Scholar
• 14 DeMonte F, Smith HK, al-Mefty O. Outcome of aggressive removal of cavernous sinus meningiomas. J Neurosurg 1994; 81 (2) 245-251
  CrossrefPubMedGoogle Scholar
• 15 Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determining the choice of approach. Neurosurg Focus 2005; 19 (2) E7
  PubMedGoogle Scholar
• 16 Feiz-Erfan I, Han PP, Spetzler RF , et al. The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg 2005; 103 (3) 485-490
  CrossrefPubMedGoogle Scholar
• 17 Hwang SK, Gwak HS, Paek SH, Kim DG, Jung HW. Guidelines for the ligation of the sigmoid or transverse sinus during large petroclival meningioma surgery. Skull Base 2004; 14 (1) 21-28; discussion 29
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Knosp E, Perneczky A, Koos WT, Fries G, Matula C. Meningiomas of the space of the cavernous sinus. Neurosurgery 1996; 38 (3) 434-442; discussion 442–444
  CrossrefPubMedGoogle Scholar
• 19 Dare AO, Balos LL, Grand W. Olfaction preservation in anterior cranial base approaches: an anatomic study. Neurosurgery 2001; 48 (5) 1142-1145; discussion 1145–1146
  CrossrefPubMedGoogle Scholar
• 20 Liu JK, Niazi Z, Couldwell WT. Reconstruction of the skull base after tumor resection: an overview of methods. Neurosurg Focus 2002; 12 (5) e9
  PubMedGoogle Scholar
• 21 O'Sullivan MG, van Loveren HR, Tew Jr JM. The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 1997; 40 (2) 238-244; discussion 245–247
  CrossrefPubMedGoogle Scholar
• 22 Sakata K, Al-Mefty O, Yamamoto I. Venous consideration in petrosal approach: microsurgical anatomy of the temporal bridging vein. Neurosurgery 2000; 47 (1) 153-160; discussion 160–161
  CrossrefPubMedGoogle Scholar
• 23 Samii M, Carvalho GA, Tatagiba M, Matthies C. Surgical management of meningiomas originating in Meckel's cave. Neurosurgery 1997; 41 (4) 767-774; discussion 774–775
  CrossrefPubMedGoogle Scholar
• 24 Sekhar LN, Burgess J, Akin O. Anatomical study of the cavernous sinus emphasizing operative approaches and related vascular and neural reconstruction. Neurosurgery 1987; 21 (6) 806-816
  CrossrefPubMedGoogle Scholar
• 25 Sekhar LN, Schramm Jr VL, Jones NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms. J Neurosurg 1987; 67 (4) 488-499
  CrossrefPubMedGoogle Scholar
• 26 Sekhar LN, Sen CN, Jho HD, Janecka IP. Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery 1989; 24 (1) 18-30
  CrossrefPubMedGoogle Scholar
• 27 Silva CE. Surgical treatment of olfactory groove meningiomas. J Bras Neurocir 2006; 17: 25-30
  PubMedGoogle Scholar
• 28 Silva CE, Freitas PEP, Romero ADCB , et al. Orbital meningiomas. J Bras Neurocir 2010; 21: 31-38
  PubMedGoogle Scholar
• 29 Silva CE, Peron CS, Nesi A, Nunes CA, Santos SC, Silveira LC. Importance of the temporal venous drainage to the petrosal approaches of the skull base. J Bras Neurocir 2009; 20: 27-32
  PubMedGoogle Scholar
• 30 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (1) 22-39
  CrossrefPubMedGoogle Scholar