Abstract
Objective The identification of cranial nerves is one of the most challenging goals in the
dissection of skull base meningiomas. The authors present an application of sodium
fluorescein (SF) in skull base meningiomas with the purpose of improving the identification
of cranial nerves.
Design A prospective study within-subjects design.
Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil.
Participants Patients with skull base meningiomas.
Main Outcomes Measures Cranial nerve identification.
Results The group of nine meningiomas was composed of one cavernous sinus, three petroclival,
one tuberculum sellae, two sphenoid wing, one olfactory groove, and one temporal floor
meningioma. The SF enhancement in all tumors was strong, and the contrast with cranial
nerves clearly evident. There were one definite olfactory nerve deficit, one transient
abducens deficit, and one definite hemiparesis. All lesions were resected (Simpson
grades 1 and 2). The analysis of the difference of the delta SF wavelength between
the meningiomas and cranial nerve contrast was performed by the Wilcoxon signed rank
test and showed p = 0.011.
Conclusions The contrast between the enhanced meningiomas and cranial nerves was evident and
assisted in the visualization and microsurgical dissection of these structures. The
anatomical preservation of these structures was improved using the contrast.
Keywords
cranial nerves - fluorescent markers - fluorescent-guided surgery - meningiomas -
sodium fluorescein
