{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:51:54Z","timestamp":1786125114329,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ mailto:journals.permissions@oup.com"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spinal cord and brain stem lesions require a judicious approach with an optimized trajectory due to a clustering of functions on their surfaces. Intraoperative mapping helps locate function. To confidently locate such lesions, neuronavigation alone lacks the desired accuracy and is of limited use in the spinal cord.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate the clinical value of fluoresceins for initial delineation of such critically located lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We evaluated fluorescein guidance in the surgical resection of lesions with blood-brain barrier disruption demonstrating contrast enhancement in magnet resonance imaging in the spinal cord and in the brain stem in 3 different patients. Two patients harbored a diffuse cervical and thoracic spinal cord lesion, respectively. Another patient suffered metastatic lesions in the brain stem and at the floor of the fourth ventricle. Low-dose fluorescein (4 mg\/kg body weight) was applied after anesthesia induction and visualized using the Zeiss Pentero 900 Yellow560 filter (Carl Zeiss, Oberkochen, Germany).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Fluorescein was helpful for locating lesions and for defining the best possible trajectory. During resection, however, we found unspecific propagation of fluorescein within the brain stem up to 6 mm within 3 h after application. As these lesions were otherwise distinguishable from surrounding tissue, monitoring resection was not an issue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Fluorescein guidance is a feasible tool for defining surgical entry zones when aiming for surgical removal of spinal cord and brain stem lesions. Unselective fluorescein extravasation cautions against using such methodology for monitoring completeness of resection. Providing the right timing, a window of pseudoselectivity could increase fluoresceins\u2019 clinical value in these cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opx269","type":"journal-article","created":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T10:45:42Z","timestamp":1514544342000},"page":"325-331","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":22,"title":["Where and When to Cut? Fluorescein Guidance for Brain Stem and Spinal Cord Tumor Surgery\u2014Technical Note"],"prefix":"10.1227","volume":"15","author":[{"given":"Eric","family":"Suero Molina","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Stummer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,9]]},"reference":[{"issue":"2","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s11060-007-9507-z","article-title":"Descriptive epidemiology of primary spinal cord tumors","volume":"87","author":"Schellinger","year":"2008","journal-title":"J Neurooncol"},{"issue":"3","key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1023\/A:1006414405305","article-title":"Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis","volume":"47","author":"Schwartz","year":"2000","journal-title":"J Neurooncol"},{"issue":"5","key":"bib3-20240909","first-page":"972","article-title":"Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases","volume":"56","author":"Raco","year":"2005","journal-title":"Neurosurgery"},{"issue":"6","key":"bib4-20240909","doi-asserted-by":"crossref","first-page":"935","DOI":"10.4184\/asj.2015.9.6.935","article-title":"Surgical outcomes of high-grade spinal cord gliomas.","volume":"9","author":"Seki","year":"2015","journal-title":"Asian Spine J"},{"issue":"4","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1038\/sj.sc.3102130","article-title":"Surgical treatment of intramedullary spinal cord tumors: prognosis and complications","volume":"46","author":"Nakamura","year":"2008","journal-title":"Spinal Cord"},{"issue":"12","key":"bib6-20240909","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/j.ejrad.2016.10.018","article-title":"Spinal diffusion tensor tractography for differentiation of intramedullary tumor-suspected lesions","volume":"85","author":"Egger","year":"2016","journal-title":"Eur J Radiol"},{"issue":"5","key":"bib7-20240909","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S1470-2045(06)70665-9","article-title":"Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial","volume":"7","author":"Stummer","year":"2006","journal-title":"Lancet Oncol"},{"issue":"5","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"10443","DOI":"10.3390\/ijms160510443","article-title":"5-ALA fluorescence image guided resection of glioblastoma multiforme: a meta-analysis of the literature","volume":"16","author":"Eljamel","year":"2015","journal-title":"IJMS"},{"key":"bib9-20240909","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jphotobiol.2015.05.002","article-title":"Fluorescence in neurosurgery: its diagnostic and therapeutic use. 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