Safeness of sodium fluorescein administration in neurosurgery: Case-report of an erroneous very high-dose administration and review of the literature

INTRODUCTION: Sodium Fluorescein has become a validated and widely used fluorescent dye in neuro-oncological surgery, thanks to its ability to accumulate in cerebral with a damaged blood–brain barrier. It concentrates at the tumor site, enhancing the lesion, and helps in the discrimination between tumor and normal brain parenchyma. RESEARCH QUESTION: This dye has a very well described profile of safeness, as a result of several applications in ophthalmology and, in recent years, also in neurosurgery. To date, no reviews are available on collateral effects of sodium fluorescein application in neurosurgery. MATERIAL AND METHODS: The case of a young woman who underwent a potentially toxic dose (almost 3 ​g) of sodium fluroescein administration during anesthesia induction for a glioma surgery due to a medical error is presented, along with a review of available articles relates to collateral effects of sodium fluorescein in neurosurgery. RESULTS: No toxic clinical phenomena occurred, and the microsurgical procedure was completed, achieving tumor gross total resection. Procedure resulted challenging due to an intense basal hyper-fluorescence, making difficult the visualization of brain tissues and the discrimination between normal brain and tumor. DISCUSSION AND CONCLUSIONS: The good clinical and laboratory outcome of this patient further strengthens the idea that fluorescein-guided removal of brain tumors may be considered safe, beyond effective. By now, this is the first report of an erroneous so high dose administration of sodium fluorescein during a neurosurgical procedure and the first review of neurosurgical-reported collateral effects.