ANS026 - Fluorescein-guided Microsurgical Resection of Vestibular Schwannoma: A Prospective Feasibility Study
Sunday, May 1, 2022
8:59 AM – 9:06 AM CT
Location: Landmark A
Stephen A. Chan, MD
Robert J. Macielak, MD
Brian A. Neff, MD
Colin L.W. Driscoll, MD
Jamie J. Van Gompel, MD
Michael J. Link, MD
Matthew L. Carlson, MD
Objective: To evaluate the optimal dose and timing of administration of fluorescein sodium (FS) for selective fluorescence of vestibular schwannoma (VS) during microsurgery with the YELLOW 560 nm microscope filter (YE560) and characterize the benefit, as determined from surgeon assessments.
Study Design: Prospective cohort study
Setting: Tertiary referral center
Patients: Adult patients undergoing VS microsurgery
Interventions: Intraoperative intravenous administration of FS and visualization with the YE560. Main Outcome Measures: Time to peak fluorescence, duration of fluorescence, correlation of fluorescence of VS with electrostimulation and white light microscopy visual assessment, and likelihood of surgeons to use FS with the YE560 in future cases.
Results: Novel use of FS and YE560 during microsurgery achieved selective fluorescence of VS with capabilities to differentiate nerve fascicles and tumor. Nuances of FS administration and timing are discussed. Correlation of differential uptake of FS by VS with electrostimulation and white light microscopy was judged to be high by surgeons. Representative images and videos utilizing YE560 and FS are presented.
Conclusions: FS and YE560 may be used in VS microsurgery to visually differentiate VS from surrounding nerves and evaluate for residual tumor capsule. Professional Practice Gap & Educational Need: FS has been used in the neurosurgical resection of intracranial neoplasms but has only been reported in 2 VS cases. There is educational need in understanding how FS can be routinely implemented in VS microsurgery. Learning Objective: Attendees will become familiar with a protocol for safe and effective use of IV FS in VS microsurgery and will understand the tissue differentiation achieved.
Desired Result: Attendees will consider the use of fluorescence in VS microsurgery.
Level of Evidence: Level III—Cohort and case-control studies
Indicate IRB or IACUC: Approved (2/21/20), IRB #19-005178, Mayo Clinic