Evaluating the Effect of Trans Surgical Fluorescein and its Relationship with Visual Prognosis in Patients with Pituitary Neuroendocrine Tumors

Abstract

Introduction: Sodium fluorescein is highly effective for neurosurgical procedures. However, its application in terms of color decompression of the vasa nervorum in sellar lesions compressing the chiasm and optic nerves remains unstudied. Additionally, the correlation between the degree of vasa nervorum filling and the visual prognosis of patient’s post-surgical resection has yet to be established.

Objective: The aim is to describe the preliminary results of a potential prognostic scale and to assess whether the degree of filling of the optic nerve vasa nervorum and optic chiasm with sodium fluorescein influences the visual prognosis of patients with Pituitary Neuroendocrine Tumors (PitNETs).

Methods: Four patients diagnosed with PitNETs underwent preoperative visual acuity assessment and campimetry. Intraoperative administration of sodium fluorescein both before and after resection was conducted to evaluate the degree of vasa nervorum filling, using a scale developed by the authors.The relationship between fluorescein instillation and patients’ visual prognosis was assessed.

Results: The disparity in vasa nervorum staining in the optic chiasm pre- and post-surgery did not impact the visual prognosis three months following surgical resection of pituitary adenomas. Statistical analysis revealed a paradoxical correlation between visual improvement and reduction in hemodynamic vasa nervorum filling. It was noted that a high preoperative score might correlate with better visual prognosis during follow-up.

Conclusion: This study provides insights into the use of fluorescein and its implications for visual prognosis in PitNETs. It was concluded that visual prognosis might be associated with a higher pre-resection score. A prospective study with a larger sample
size is necessary to confirm these preliminary findings.