Operative Neurosurgery’s Editor’s Choice: Fluorescein-Guided Neuroendoscopy for Intraventricular Lesions: A Case Series

Neuroendoscopy plays a consistent role in the management of intra- and paraventricular tumors, enabling not only lesion biopsy or removal, but also allowing the simultaneous treatment of a possible concurrent hydrocephalus by endoscopic third ventriculostomy (ETV). Most authors do, however, agree that neuroendoscopic biopsy can often be inconclusive, with a failure rate of over 30%, mainly due to minute and frequently inadequate sample size.14 Fluorescent techniques, already adopted for microsurgical brain tumor removal and endonasal transsphenoidal surgery,510 have also been proposed in neuroendoscopy to better define tumor borders, to enhance their more aggressive portion, and for safer biopsy targeting. Neuroendoscopic tumor sampling guided by 5-aminolevulinic acid (5-ALA) fluorescence has attained this goal with some success in isolated cases,1112 while indocyanine green (ICG) fluorescence did not improve visualization of the tumor per se but proved more suitable to visualize vessels more clearly.3 Fluorescein sodium (FS) is an outdated fluorescent dye, commonly and widely used for the diagnosis and treatment of retinal disorders.13 It is not a metabolic marker, but it can trespass the blood–brain barrier (BBB) when damaged. FS has been adopted in neurosurgery since 1947 as a trial guide tool in the macroscopic surgical removal of high-grade gliomas,5 and new technical utilities have contributed to the revival of this technique in the microsurgical field.6,8,14 It should be noted that FS sodium is inexpensive (5€ for each vial), especially compared to the costs of 5-ALA.8

From Fluorescein-Guided Neuroendoscopy for Intraventricular Lesions: A Case Series by Alessandro Fiorindi, MD, PhD, Alessandro Boaro, MD, Giulia Del Moro, MD, Pierluigi Longatti, MD