Application of functional neuronavigation combined with intraoperative sodium fluorescein and intraoperative ultrasound in surgery for brain metastases

doi:10.3877/cma.j.issn.2095-9141.2026.02.009

Abstract

Abstract:

Brain metastasis (BM) refers to the spread of malignant tumors from other parts of the body to the brain and is one of the most common tumors of the central nervous system. Although the incidence of BM is high, there is still no universally accepted optimal treatment strategy, and surgery remains one of the main treatment modalities. Surgical adjuncts such as neuronavigation, intraoperative ultrasound (iOUS), and Fluorescein sodium (FLS) play important roles in BM surgery and contribute to achieving gross total resection. However, the application and standardization of these auxiliary techniques in neurosurgery remain insufficient, which may lead to differences in surgical efficacy and safety, thereby affecting the completeness of tumor resection and postoperative recovery of patients. This article reviews the latest advances in the application of neuronavigation, iOUS, and FLS in BM surgery, with the aim of clarifying their potential clinical value and future application prospects.

Key words: Brain metastasis, Neuronavigation, Intraoperative ultrasound, Fluorescein sodium, Multimodal joint technology

Fei Wang, Zhong Wang. Application of functional neuronavigation combined with intraoperative sodium fluorescein and intraoperative ultrasound in surgery for brain metastases[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2026, 12(02): 118-122.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2026.02.009

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2026/V12/I02/118

References 39

[1]	Lamba N, Wen PY, Aizer AA. Epidemiology of brain metastases and leptomeningeal disease[J]. Neuro Oncol, 2021, 23(9): 1447-1456. DOI:10.1093/neuonc/noab101.
[2]	Hatiboglu MA, Akdur K, Sawaya R. Neurosurgical management of patients with brain metastasis [J]. Neurosurg Rev, 2020, 43(2): 483-495. DOI: 10.1007/s10143-018-1013-6.
[3]	Winther RR, Hjermstad MJ, Skovlund E, et al. Surgery for brain metastases-impact of the extent of resection[J]. Acta Neurochir (Wien), 2022, 164(10): 2773-2780. DOI: 10.1007/s00701-021-05104-7.
[4]	Aizer AA, Lamba N, Ahluwalia MS, et al. Brain metastases: a Society for Neuro-Oncology (SNO) consensus review on current management and future directions[J]. Neuro Oncol, 2022, 24(10): 1613-1646. DOI: 10.1093/neuonc/noac118.
[5]	Sacks P, Rahman M. Epidemiology of brain metastases[J]. Neurosurg Clin N Am, 2020, 31(4): 481-488. DOI: 10.1016/j.nec.2020.06.001.
[6]	Rouse C, Gittleman H, Ostrom QT, et al. Years of potential life lost for brain and CNS tumors relative to other cancers in adults in the United States, 2010[J]. Neuro Oncol, 2016, 18(1): 70-77. DOI: 10.1093/neuonc/nov249.
[7]	Steindl A, Yadavalli S, Gruber K A, et al. Neurological symptom burden impacts survival prognosis in patients with newly diagnosed non-small cell lung cancer brain metastases[J]. Cancer, 2020, 126(19): 4341-4352. DOI: 10.1002/cncr.33085.
[8]	Zhu Y, Cui Y, Zheng X, et al. Small-cell lung cancer brain metastasis: from molecular mechanisms to diagnosis and treatment[J]. Biochim Biophys Acta Mol Basis Dis, 2022, 1868(12): 166557. DOI: 10.1016/j.bbadis.2022.166557.
[9]	Kim YJ, Kim JS, Kim IA. Molecular subtype predicts incidence and prognosis of brain metastasis from breast cancer in SEER database [J]. J Cancer Res Clin Oncol, 2018, 144(9): 1803-1816. DOI: 10.1007/s00432-018-2697-2.
[10]	Sun H, Xu J, Dai S, et al. Breast cancer brain metastasis: current evidence and future directions[J]. Cancer Med, 2023, 12(2): 1007-1024. DOI: 10.1002/cam4.5021.
[11]	Cagney DN, Martin AM, Catalano PJ, et al. Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study[J]. Neuro Oncol, 2017, 19(11): 1511-1521. DOI: 10.1093/neuonc/nox077.
[12]	Samlowski WE, Moon J, Witter M, et al. High frequency of brain metastases after adjuvant therapy for high-risk melanoma[J]. Cancer Med, 2017, 6(11): 2576-2585. DOI: 10.1002/cam4.1223.
[13]	Niedermeyer S, Schmutzer-Sondergeld M, Weller J, et al. Neurosurgical resection of multiple brain metastases: outcomes, complications, and survival rates in a retrospective analysis[J]. J Neurooncol, 2024, 169(2): 349-358. DOI: 10.1007/s11060-024-04744-w.
[14]	Lamba N, Muskens IS, DiRisio AC, et al. Stereotactic radiosurgery versus whole-brain radiotherapy after intracranial metastasis resection: a systematic review and meta-analysis[J]. Radiat Oncol, 2017, 12(1): 106. DOI: 10.1186/s13014-017-0840-x.
[15]	Loh D, Hogg F, Edwards P, et al. Two-year experience of Multi-Disciplinary Team (MDT) outcomes for brain metastases in a tertiary neuro-oncology centre [J]. Br J Neurosurg, 2018, 32(1): 53-60. DOI: 10.1080/02688697.2017.1368449.
[16]	Cardinal T, Pangal D, Strickland BA, et al. Anatomical and topographical variations in the distribution of brain metastases based on primary cancer origin and molecular subtypes: a systematic review [J]. Neurooncol Adv, 2022, 4(1): vdab170. DOI: 10.1093/noajnl/vdab170.
[17]	Cacho-Díaz B, Lorenzana-Mendoza NA, Chávez-Hernandez JD, et al. Clinical manifestations and location of brain metastases as prognostic markers [J]. Curr Probl Cancer, 2019, 43(4): 312-323. DOI: 10.1016/j.currproblcancer.2018.06.002.
[18]	Krauss P, Kahl KH, Bonk MN, et al. Intraoperative radiotherapy after resection of brain metastases located in the posterior fossa. Analysis of postoperative morbidity and mortality in a single center cohort[J]. J Clin Neurosci, 2023, 118: 1-6. DOI: 10.1016/j.jocn.2023.09.014.
[19]	Prete AA, Angerilli V, Bergamo F, et al. HER2 expression and genOmic characterization of rESected brain metastases from colorectal cancer: the HEROES study[J]. Br J Cancer, 2024, 130(8): 1316-1323. DOI: 10.1038/s41416-023-02569-4.
[20]	Yri OE, Astrup GL, Karlsson AT, et al. Survival and quality of life after first-time diagnosis of brain metastases: a multicenter, prospective, observational study[J]. Lancet Reg Health Eur, 2025, 49: 101181. DOI: 10.1016/j.lanepe.2024.101181.
[21]	Nie Y, Ying B, Lu Z, et al. Predicting survival and prognosis of postoperative breast cancer brain metastasis: a population-based retrospective analysis[J]. Chin Med J (Engl), 2023, 136(14): 1699-1707. DOI: 10.1097/cm9.0000000000002674.
[22]	Chen TW, Dai MS, Tseng LM, et al. Whole-brain radiotherapy alone vs preceded by bevacizumab, etoposide, and cisplatin for untreated brain metastases from breast cancer: a randomized clinical trial[J]. JAMA Oncol, 2024, 10(3): 325-334. DOI: 10.1001/jamaoncol.2023.5456.
[23]	Kermanshahi N, Hamidi N, Weisberg J, et al. The prevalence of seizures in brain metastasis patients on anticonvulsant prophylaxis: a systematic review and meta-analysis[J]. World Neurosurg, 2024, 183: e613-e624. DOI: 10.1016/j.wneu.2023.12.154.
[24]	Le Rhun E, Guckenberger M, Smits M, et al. EANO-ESMO clinical practice guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours[J]. Ann Oncol, 2021, 32(11): 1332-1347. DOI: 10.1016/j.annonc.2021.07.016.
[25]	Tejada Solís S, Iglesias Lozano I, Meana Carballo L, et al. Brain metastasis treatment guidelines: consensus by the spanish society of neurosurgery tumor section[J]. Neurocirugía (English Edition), 2023, 34(6): 308-320. DOI: 10.1016/j.neucie.2023.07.010.
[26]	朱雷,雷奕,莫立根,等.神经导航联合荧光素钠术中显影辅助切除脑转移瘤的应用分析[J].中国癌症防治杂志, 2023, 15(6): 657-662. DOI: 10.3969/j.issn.1674-5671.2023.06.10.
[27]	West TR, Mazurek MH, Perez NA, et al. Navigated intraoperative ultrasound offers effective and efficient real-time analysis of intracranial tumor resection and brain shift[J]. Oper Neurosurg, 2025, 28(2): 148-158. DOI: 10.1227/ons.0000000000001250.
[28]	Sulangi AJ, Husain A, Lei H, et al. Neuronavigation in glioma resection: current applications, challenges, and clinical outcomes[J]. Front Surg, 2024, 11: 1430567. DOI: 10.3389/fsurg.2024.1430567.
[29]	Catapano G, Sgulò FG, Acurio Padilla PE, et al. Palatal position of patient tracker for magnetic neuronavigation system: technical note[J]. World Neurosurg, 2018, 116: 105-109. DOI: 10.1016/j.wneu.2018.04.221.
[30]	Dixon L, Lim A, Grech-Sollars M, et al. Intraoperative ultrasound in brain tumor surgery: a review and implementation guide[J]. Neurosurg Rev, 2022, 45(4): 2503-2515. DOI: 10.1007/s10143-022-01778-4.
[31]	Coburger J, Scheuerle A, Pala A, et al. Histopathological insights on imaging results of intraoperative magnetic resonance imaging, 5-aminolevulinic acid, and intraoperative ultrasound in glioblastoma surgery[J]. Neurosurgery, 2017, 81(1): 165-174. DOI: 10.1093/neuros/nyw143.
[32]	Giussani C, Trezza A, Ricciuti V, et al. Intraoperative MRI versus intraoperative ultrasound in pediatric brain tumor surgery: is expensive better than cheap? A review of the literature[J]. Childs Nerv Syst, 2022, 38(8): 1445-1454. DOI: 10.1007/s00381-022-05545-0.
[33]	Giammalva GR, Ferini G, Musso S, et al. Intraoperative ultrasound: emerging technology and novel applications in brain tumor surgery[J]. Front Oncol, 2022, 12: 818446. DOI: 10.3389/fonc.2022.818446.
[34]	Wu H, Cheng Y, Gao W, et al. Progress in the application of ultrasound in glioma surgery[J]. Front Med (Lausanne), 2024, 11: 1388728. DOI: 10.3389/fmed.2024.1388728.
[35]	Ahrens LC, Krabbenhøft MG, Hansen RW, et al. Effect of 5-aminolevulinic acid and sodium fluorescein on the extent of resection in high-grade gliomas and brain metastasis[J]. Cancers (Basel), 2022, 14(3): 617. DOI: 10.3390/cancers14030617.
[36]	陈立华,夏勇,徐如祥.术中荧光在神经肿瘤手术中的临床应用[J].中华神经创伤外科电子杂志, 2022, 8(2): 111-116. DOI: 10.3877/cma.j.issn.2095-9141.2022.02.010.
[37]	Musca B, Bonaudo C, Tushe A, et al. Sodium fluorescein uptake by the tumor microenvironment in human gliomas and brain metastases[J]. J Neurosurg, 2024, 140(4): 958-967. DOI: 10.3171/2023.7.JNS23873.
[38]	Schatlo B, Stockhammer F, Barrantes-Freer A, et al. 5-aminolevulinic acid fluorescence indicates perilesional brain infiltration in brain metastases[J]. World Neurosurg X, 2019, 5: 100069. DOI: 10.1016/j.wnsx.2019.100069.
[39]	Madani D, Fonseka RD, Kim SJ, et al. Comparing the rates of further resection after intraoperative MRI visualisation of residual tumour between brain tumour subtypes: a 17-year single-centre experience[J]. Brain Sci, 2025, 15(1): 45. DOI: 10.3390/brainsci15010045.

Please choose a citation manager

Content to export