Adjuvant use of fluorescein sodium for maximizing resection of high-grade gliomas: An institutional experience with review of the literature

Abstract

Background: The extent of resection of high-grade gliomas (HGGs), in order to limit tumor recurrence and above all to improve disease-free survival rates cannot be overstated. Several fluorescent biomarkers have been tested and are in use to aid intraoperative identification of residual tumor; 5aminolevulinic acid and fluorescein sodium are now playing a pivotal role in glioma surgery. A retrospective analysis on 29 patients operated for HGGs and the results are presented here. Materials and Methods: Data of 29 consecutive patients with HGG have been collected in our study (16 males and 13 females; mean age: 60.3 years, range: 23–90 years). Fluorescein (7 mg/kg of body weight) was injected intravenously right after the induction of general anesthesia. A YELLOW 560 filter was used on a Leica M530 OHX surgical microscope (Leica microsystems, Wetzlar, Germany) to aid in a complete microsurgical tumor removal. Glioma resection and quality of life were evaluated preoperative and postoperatively. Results: Gross total resection was achieved in 41.3% (n = 12) of patients. A subtotal resection (>95%) was achieved in 48.2% (n = 14) of them, while a PR ( 95%. No adverse effects correlated to fluorescein have been recorded. Conclusions: Fluorescein proved itself to be safe and abundantly effective in the resection of HGGs, allowing a high rate of gross total removal of contrast-enhanced tumor areas.