Objective:

The objectives of this study are to assess the safety of sodium fluorescein (SF) and its utility in obtaining total VS resection while avoiding facial nerve compromise.

Background:

Vestibular schwannomas are benign intracranial tumors originating from the vestibulocochlear nerve Schwann cells. Because of their closeness to the large neurovascular bundles especially the facial nerve, there are many surgical considerations. The balance between tumor resection and nerve preservation is optimal. Fluorescein is a fluorescent dye that has been gradually used in neurosurgery, especially in tumor resection, but it has limited literature and study about its safety and effectiveness in VS surgery.

Design/Methods:

In 55 patients with VS, who underwent microsurgery using the retro-sigmoid approach, we employed SF (5 mg/kg) for intraoperative tumor delineation. Tumor size was measured according to Koos grading, facial nerve function according to House-Brackmann grading, and safety was evaluated by serum creatinine levels.

Results:

The studied cohort included 55 patients, their mean age was 51.36 ± 10.94 years, and the majority of the participants were female (58.2%) and the mean maximum diameter of the tumor was 2.34 cm. Patients were categorized by fluorescein uptake into three groups: as very useful (N = 22), useful (N =30), and non-useful (N = 4). The findings analysis showed that there was a significant difference between the groups in terms of tumor resection (p = 0.029). Consequently, increased uptake of the fluorescein was associated with lesser Koos grades (p = 0.025). However, after the surgery, the serum creatinine concentration reduced significantly (p = 0.000), showing no renal side effects.

Conclusions:

This study shows that sodium fluorescein is not toxic to the kidneys and can be safely used in VS surgeries. It greatly improves the degree of tumor identification and resection, improving facial nerve preservation and surgical outcome in cases of low Koos grade.