Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms and their management involves tumors resection in most cases. Regarding the surgical procedure, adequate identification of tumor boundaries is paramount to achieve an extensive tumor resection. Fluorescence image–guided surgery (FIGS) has become an increasing popular intraoperative technique used in spine neuro-oncology surgery. However, evidence is lacking of their usefulness and their safety in spinal tumors. Therefore, the aim of the present study is to give an update of the existing literature and systematically review all studies that focus on the most-used fluorophores (5 aminolevulinic acid [5-ALA], sodium fluorescein, and indocyanine green [ICG]) in IMSCTs.

In intramedullary tumor surgery, 5-ALA has shown its usefulness in identifying the tumor margins and in searching for residues because of its properties as a tumor-specific metabolic marker. Sodium fluorescein and ICG video angiography have shown promising application in ependymoma and hemangioblastomas surgery, respectively.Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms, accounting for 2%–4% of all central nervous system (CNS) tumors. In the adult population, the most frequent primary IMSCT is ependymoma, followed by astrocytoma, hemangioblastoma, ganglioglioma, germinoma, primary CNS lymphoma, and melanoma; in addition, although rare, spinal cord metastasis account for 2.1% of all patients with cancer. Management of IMSCTs involves tumor resection in most cases, with radiotherapy and chemotherapy reserved for recurrence or when surgical resection is contraindicated.

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Mishita
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Journal of General Surgery Reports