Sodium fluorescein guided resection of a foot schwannoma

Abstract

We report the use of sodium fluorescein (SF) as an additional visualization tool during resection of a schwannoma of the foot. A 56-year-old woman presented with excruciating left foot pain that was aggravated by standing and associated with paresthesia under her foot. Magnetic resonance imaging (MRI) revealed a contrast-enhancing lesion in the region of the medial plantar nerve. Microsurgical excision of the lesion was performed with intraoperative neurological monitoring and sodium fluorescein (SF) as a visual aid. Following administration of SF intravenously, under the Yellow-560 filter lens of the operating microscope, the schwannoma demonstrated a bright green fluorescence that distinguished it from adjacent normal structures. A complete resection of the tumor was achieved and the patient's symptoms resolved completely. No complications were noted due to the SF administration. The patient remains symptom-free at a 1.5-year follow-up with no evidence of tumor recurrence. SF is a safe and effective tool to assist visualization of schwannomas of the foot.

Keywords

• Medial plantar nerve
• Schwannoma
• Neurilemoma
• Sodium fluorescein