Fluorescent Intraoperative Diagnosis in Schwannoma Surgery — Literature Review

Schwannoma is a benign, encapsulated, and slowly growing tumor of Schwann cell origin and is rare in the peripheral nervous system. Schwannoma surgery should be performed with a low risk of postoperative neurological complications, with the maximum possible removal of tumor volume, and an acceptable reduction in clinical symptoms. The use of fluorescent navigation during surgery may bring the surgeon closer to the balance in achieving these goals. Purpose of the study. Analysis of scientific publications reporting on the possibilities and results of using fluorescent diagnostics in schwannoma surgery. Materials. Data were collected from various databases MEDLINE, Cochrane Controlled Trials Register, Pub Med reporting on the use of fluorescent diagnostics in schwannomas of various localizations. Results. All authors who used sodium fluorescein and indocyanine green reported that the use of fluorescence in schwannomas surgery improved the visual differentiation of the tumor from the surrounding nerves, and increased the radicalness of the surgical intervention. The authors using 5-aminolevulinic acid as a fluorescence inducer noted the absence of fluorescence in all cases of schwannomas, and thus the lack of benefit during surgery. Conclusion. It is necessary to further study the possibilities of fluorescent navigation in schwannoma surgery in order to improve the quality of the surgical intervention. The latest data of scientific publications demonstrate impressive results in this direction, expanding the operational possibilities in schwannoma surgery. 

1. Tiel r, Kline d. peripheral nerve tumors: Surgical principles, approaches, and techniques. Neurosurg Clin N am. 2004; 15: 167– 175. https://doi.org/10.1016/j.nec.2004.02.003

2. Babu r, Sharma r, Bagley jH, Hatef j, Friedman aH, adamson C. vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. j Neurosurg. 2013; 119(1): 121–130. https://doi.org/10.3171/2013.1.jNS 121370.

3. ostrom qT, Cioffi g, waite K, Kruchko C, Barnholtz-Sloan jS. CBTruS Statistical report: primary Brain and other Central Nervous System Tumors diagnosed in the united States in 2014–2018 Neuro. oncol. 2021; 23: III1-III105. https://doi.org/10.1093/NeuoNC/NoaB 200

4. louis dN, perry a, wesseling p, Brat dj, Cree Ia, Figarella-Branger d et al. The 2021 wHo classification of tumors of the central nervous system: a summary. Neuro oncol. 2021; 23:1231–1251. https://doi.org/10.1093/neuonc/noab106

5. guha d, davidson B, Nadi m, alotaibi Nm, Fehlings mg, gentili F et al. management of peripheral nerve sheath tumors: 17 years of experience at Toronto western hospital. j Neurosurg. 2018; 128: 1226–1234. https://doi.org/10.3171/2017.1.jNS 162292

6. rynda a. yu., rostovtsev d. m., olyushin v. e. Fluorescence-guided resection of glioma — literature review. russian Neurosurgical journal named after professor a. l. polenov, 2018, vol. x, no.1, pp.97–110. (In russ.).

7. goryaynov S. a., potapov a. a., okhlopkov v. a., Batalov a. I., afandiev r. o., Belyaev a. yu., aristov a. a., Caveleva T. a., Zhukov v. yu., loshchenov v. B., gusev d. v., Zakharova N. e. metabolic navigation during brain tumor surgery: analysis of a series of 403 patients. russian journal of neurosurgery. 2022;24(4):46–58. (In russ.) https://doi.org/10.17650/1683-32952022-24-4-46-58

8. Konovalov Na, Timonin Syu, Zelenkov pv, goryainov Sa, asyutin dS, Zakirov Ba, Kaprovoy Sv. visual fluorescence combined with laser spectroscopy in surgery for intramedullary spinal cord tumors. Zhurnal voprosy Neirokhirurgii Imeni N. N. Burdenko. 2020;84(6):5– 14. (In russ.) https://doi.org/10.17116/neiro2020840615

9. Stone jj, graffeo CS, de ruiter gCw, rock mg, Spinner rj. Intraoperative intravenous fluorescein as an adjunct during surgery for peroneal intraneural ganglion cysts. acta Neurochir. 2018; 160: 651–654. https://doi.org/10.1007/s00701-018-3477-0

10. rynda a. yu., olyushin v. e., rostovtsev d. m., Zabrodskaya y. m., papayan g. v. Fluorescent diagnostics with chlorin e6 in surgery of low-grade glioma. Biomedical photonics. 2021;10(4):35–43. (In russ.). https://doi.org/10.24931/2413-9432-2021-10-4-35-43

11. Szczupak m, peña Sa, Bracho o et al. Fluorescent detection of vestibular Schwannoma using Intravenous Sodium Fluorescein In vivo. otol Neurotol. 2021; 42(4): e503–e511. https://doi.org/10.1097/mao.0000000000002988.

12. pedro mT, eissler a, Schmidberger j, Kratzer w, wirtz Cr, antoniadis g, Koenig rw. Sodium Fluorescein-guided Surgery in peripheral Nerve Sheath Tumors: First experience in 10 Cases of Schwannoma. world Neurosurg. 2019; S 1878–8750. https://doi.org/10.1016/j.wneu.2019.01.010.

13. pedro mT, grübel N, durner g, pala a, wirtz Cr, Koenig rw. Intraoperative Sodium-Fluorescence Imaging in peripheral Nerve Sheath Tumors (pNST) — a New additional promising diagnostic Tool. Front. oncol. 2021; 11: 655392. https://doi.org/10.3389/fonc.2021.655392

14. Chan Sa, macielak rj, Tuchscherer am, Neff Ba, driscoll Clw, peris-Celda m, van gompel jj, link m, Carlson ml. Fluoresceinassisted microsurgical resection of vestibular Schwannoma: a prospective Feasibility Study. otology and Neurotology. 2022; 43(10): 1240–1244. https://doi.org/10.1097/mao.0000000000003718

15. Nazzi v, Innocenti N, Castelli N et al. 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. https://doi.org/10.3389/fonc.2022.1070878.

16. vetrano Ig, acerbi F, Falco j, devigili g, Tech Sr, messina g, prada F, d’ammando a, Nazzi v. Fluorescein-guided removal of peripheral nerve sheath tumors: a preliminary analysis of 20 cases. j Neurosurg. 2019; 134(1): 260–269. https://doi.org/10.3171/2019.9.jNS19970

17. vetrano Ig, Nazzi v, acerbi F. what is the advantage of using sodium fluorescein during resection of peripheral nerve tumors? acta Neurochir. 2020; 162: 1153–1155. https://doi.org/10.1007/s00701-019-04209-4

18. Kalamarides m, Bernat I, peyre m. extracapsular dissection in peripheral nerve schwannoma surgery using bright light and fluorescein sodium visualization: case series. acta Neurochirurgica. 2019; 161(1): 2447–2452. https://doi.org/10.1007/s00701-019-04071-4

19. Kvint S, Ifrach j, Buch ly, Singhal S, ali ZS. Indocyanine-green for fluorescence-guided surgery of peripheral nerve sheath tumors — a case report. Interdisciplinary Neurosurgery. 2021; 23: 100983. https://doi.org/10.1016/j.inat.2020.100983

20. peng Ka, lekovic gp. Intraoperative Fluorescence with Second window Indocyanine green enhances visualization during vestibular Schwannoma Surgery. otology & Neurotology. 2022; 43(2)1: e259-e262. https://doi.org/10.1097/mao.0000000000003400

21. muto j, mine y, Nagai S et al. utility of intraoperative real-time near-infrared fluorescence surgery for spinal schwannoma. Neurosurg Focus video. 2022; 6 (1): v12. https://doi.org/10.3171/2021.10.FoCvId 21158

22. da Silva jr eB, ramina r, Neto mC et al. extending the Indications of 5-aminolevulinic acid for Fluorescence-guided Surgery for different Central Nervous System Tumors: a Series of 255 Cases in latin america. arq Bras Neurocir. 2022; 41(1): e35–e42. https://doi.org/10.1055/s-0041–1739272.

23. millesi m, Kiesel B, woehrer a, Hainfellner ja, Novak K, martínezmoreno m et al. analysis of 5-aminolevulinic acid-induced fluorescence in 55 different spinal tumors. Neurosurg Focus. 2014; 36: e 11. https://doi.org/10.3171/2013.12.FoCuS13485

24. wainwright jv, endo T, Cooper jB, Tominaga T, Schmidt mH. The role of 5-aminolevulinic acid in spinal tumor surgery: a review. j Neurooncol. 2019; 141: 575–584. https://doi.org/10.1007/s11060-018-03080-0

25. marbacher S, Klinger e, Schwyzer l, Fischer I, Nevzati e, diepers m, et al. use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases. Neurosurg Focus. 2014; 36: e 10. https://doi.org/10.3171/2013.12.FoCuS13464

26. rynda a. yu., olyushin v. e., rostovtsev d. m., Zabrodskaya yu.m., Tastanbekov m. m., papayan g. v. Intraoperative fluorescence control with chlorin e 6 in resection of glial brain tumors. Zhurnal voprosy Neirokhirurgii Imeni N. N. Burdenko, 2021, vol.85, no.4, pp.20–28. (In russ.). https://doi.org/10.17116/neiro20218504120.

27. rynda ayu, olyushin ve, rostovtsev dm, Zabrodskaya yum, papayan gv. Comparative analysis of 5-ala and chlorin e 6 fluorescence-guided navigation in malignant glioma surgery. pirogov russian journal of Surgery = Khirurgiya. Zurnal im. N. I. pirogova. 2022;(1):5–14. (In russ.). https://doi.org/10.17116/hirurgia20220115

28. matsumura y, maeda H. a new concept for macromolecular therapeutics in cancer chemotherapy: mechanism of tumoritropic accumulation of proteins and the antitumor agent smancs. pt 1Cancer res. 1986; 46: 6387–6392.

29. rynda a. yu., olyushin v. e., rostovtsev d. m., Kukanov K. K., pustovoi S. v., Zabrodskaya yu. m. possibilities of intraoperative fluorescent bioimaging of nerves in neurosurgical practice. rossiiskii neirokhirurgicheskii zhurnal im. professora a. l. polenova. 2023;15(1):68–83. doI 10.56618/2071–2693_2023_15_1_68. (In russ.).

30. dolgushin a.a., murzaeva d.a., orlov a.yu., Zabrodskaya yu.m., Nazarov a. S., Kudziev a. v. Hirurgicheskoe lechenie recidivov opuholej obolochek perifericheskih nervov / a. a. dolgushin,

31. d. a. murzaeva, a.yu.orlov, yu.m. Zabrodskaya, a. S. Nazarov, a. v. Kudziev. — rossijskij nejrohirurgicheskij zhurnal im. professora a. l. polenova. 2022;14(1–2):53–58.(In russ.).

32. orlov a.yu., dolgushin a. a., Nazarov a. S., Kudziev a. v., olejnik e.a. Bol’shie i gigantskie opuholi obolochek perifericheskih nervov. a.yu.orlov, a.a. dolgushin, a. S. Nazarov, a. v. Kudziev, e.a. olejnik. — rossijskij nejrohirurgicheskij zhurnal im. professora a. l. polenova. 2020;12(3):22–30. (In russ.).