Fluorescein in brain metastasis and glioma surgery

Fluorescein is being investigated for fluorescence-guided resections of brain metastasis and gliomas [1][2][3].Eager to exploit the new potential of this application, our group is also exploring fluorescein, and has been exploring it for a while.However, in our hands we are having continuing problems using this method and are simply not observing the selectivity that we would desire.In our experience with metastases (Fig. 1) and malignant gliomas (Supplementary Video), significant fluorescein fluorescence is found after resection at the margins in obviously normal and perifocal edematous brain tissue despite all efforts to follow the guidance of Dr. Acerbi and coworkers using low doses (4 mg/kg) given with induction of anesthesia and performing surgery with the Zeiss Yellow 560 filter system.This confounds applicability.