Introduction: Peripheral nerve sheath tumors (PNST) include schwannomas that are generally benign, slow-growing neoplasms originating from Schwann cells. The optimal management for symptomatic or growing schwannomas is maximal, safe resection and Sodium Fluorescein (SF) has been utilized to facilitate this.
Methods: This retrospective single-institution review evaluated patients over a 5-year period (2019-2023) with PNST-schwannomas who underwent a microscopic resection of the tumor with 1mg/kg intravenous SF administration. Intraoperative neurophysiological monitoring and nerve stimulation was employed in all cases. Patient demographic as well as pertinent clinical data through follow up visits at 2 weeks, 3 months, and 1 year were recorded.
Results: 19 patients underwent SF-assisted microsurgical resection of PNST-schwannomas. Average operative time was 142 minutes. Average follow-up period was 3.9 months. The distinction between tumor tissue and the normal nerve fascicles was possible under white-light illumination. Under the yellow-560 lens filter, tumor tissue displayed a bright-green fluorescence also allowing the surgeon to distinguish tumor tissue from normal nerve fascicles in 15/19 tumors (79%). In terms of clinical outcome, 14/19 (74%) patients presented with pain and 12/14 (86%) showed improvement; 4/19 (21%) presented with a motor deficit and 3/4 (75%) showed improvement; 7/19 (37%) presented with a sensory deficit and 2/7 (29%) showed improvement. No new or worsening pain or motor deficits were observed post-operatively. No adverse effects of SF use were reported. The cost of SF was $32.64 per vial.
Conclusion : Sodium Fluorescein is a viable, cost-effective, and safe option to differentiate tumor from healthy nerve fascicles for maximal safe surgical resection. Distinction between tumor tissue and normal nerve fascicles is also possible under white-light illumination.
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