{"id":"546f4cbc-347a-4164-a679-bcbe8b625f7c","slug":"neurosurgery-concepts-key-perspectives-on-intrathecal-fluorescein-for-detecting-intraoperative-cerebrospinal-fluid-leak-during-endoscopic-endonasal-surgery-spinal-intraarterial-chemotherapy-oligoas","title":"Neurosurgery concepts: Key perspectives on intrathecal fluorescein for detecting intraoperative cerebrospinal fluid leak during endoscopic endonasal surgery, spinal intraarterial chemotherapy, oligoastrocytoma classification by <i>in situ</i> molecular genetics, and prenatal myelomeningocele closure and the need for cerebrospinal fluid shunt placement","authors":["Anand V. Germanwala","Winward Choy","Jonathan H. Sherman","Sandi Lam","Isaac Yang","Zachary A. Smith"],"abstract":"Background: This article discusses several neurosurgery concepts, including the use of intrathecal fluorescein for detecting intraoperative cerebrospinal fluid (CSF) leaks during endoscopic endonasal surgery, spinal intraarterial chemotherapy, and the classification of oligoastrocytomas using in situ molecular genetics. The significance of these topics lies in their potential to improve surgical outcomes and treatment strategies for patients with complex neurological conditions. Methods: The study on intrathecal fluorescein involved a prospective analysis of 419 patients undergoing endoscopic endonasal skull base surgery, where fluorescein was administered prior to surgery to detect intraoperative CSF leaks. For spinal intraarterial chemotherapy, a Phase I clinical trial was conducted with patients receiving Melphalan via intraarterial delivery, with follow-up assessments through spinal MRI. The oligoastrocytoma classification study utilized immunohistochemistry and fluorescence in situ hybridization to analyze tumor specimens. Results: The use of intrathecal fluorescein demonstrated a sensitivity of 92.9% and specificity of 100% for detecting intraoperative CSF leaks, with a low postoperative leak rate. In the spinal intraarterial chemotherapy trial, tumor size remained stable or decreased in most patients, with only one case of neutropenic fever reported. The molecular genetics study found that IDH1 R132H mutations and 1p/19q co-deletions could effectively differentiate between oligodendrogliomas and astrocytomas. Conclusion: Intrathecal fluorescein is a valuable tool for identifying intraoperative CSF leaks with high accuracy, while spinal intraarterial chemotherapy shows promise for patients with advanced metastatic spinal tumors. The use of molecular genetics in glioma classification enhances diagnostic precision and may influence treatment decisions, highlighting the evolving landscape of neurosurgical practice. Keywords: intrathecal fluorescein, cerebrospinal fluid leak, spinal intraarterial chemotherapy, oligoastrocytoma, molecular genetics, endoscopic surgery, neurosurgery","thumbnailUrl":null,"publishDate":"2016-10-07T00:00:00.000Z","doi":"10.4103/2152-7806.192495","categories":["General Neurosurgery","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2016/11/8040/SNI-7-715.pdf"}