Clinical study of functional neuronavigation combined with intraoperative fluorescein sodium guided technique in the surgery of brain metastases

Abstract

Purpose To evaluate the efficacy of functional neuronavigation combined with intraoperative fluorescein sodium in the operation of brain metastases. Patients and methods From January 2018 to December 2023, 80 patients with brain metastases were divided into observation and control groups based on using sodium fluorescein during surgery. Magnetic resonance image (MRI) and other imaging sequences, were performed, and the image data were imported into Brainlab functional nervous navigation software before the operation. The specific location of the tumor tissue, cone bundle, the spatial relationship of the great vessels, and image fusion with the skull multi-plane computed tomography was used to determine the surgical navigation plan. A standardized sodium fluorescein allergy test was performed after induction of general anesthesia, with predefined diagnostic criteria for hypersensitivity. Intravenous low-dose fluorescein sodium (2 mg/kg) was administered following a negative test. Intraoperatively, neuronavigation was combined with sodium fluorescein to perform tumor resection by displaying the border between tumor tissue and normal brain tissue using the YELLOW 560 fluorescence mode of a Zeiss Pentero 900 microscope. Results The observation group revealed a significantly better tumor resection outcome than the control group, with a statistically significant difference ( X 2 = 6.144, P = 0.013). Postoperative Karnofsky performance status scores in the observation group were also significantly improved than the control group ( X 2 = 4.286, P = 0.038) Additionally, the observed group experienced fewer new-onset functional impairments postoperatively, with a statistically significant difference ( X 2 = 4.800, P = 0.028). Although the observation group had fewer postoperative complications than the control group, this difference was not statistically significant ( X 2 = 2.294, P = 0.130). The surgical time in the observation group (216.65 ± 56.76) was shorter than the control group (225.62 ± 37.68), however, the difference was not statistically significant (t=0.589, P = 0.560). Similarly, the length of hospitalization in the observation group (21.48 ± 3.23) was lower than that in the control group (22.43 ± 2.34), however, the difference was statistically insignificant (t=1.065, P = 0.294). Conclusion Multimodal functional neuronavigation combined with intraoperative sodium fluorescein guidance is a safe and feasible technique for brain metastasis surgery. It enables accurate tumor localization, delineates the boundary between the tumor and surrounding normal brain tissue, increases the extent of resection, and reduces postoperative neurological deficits without increasing complications, thereby improving patients’ quality of life and functional outcomes.