Combined application of neuronavigation and yellow fluorescein-guided techniques in the operations of brain gliomas

Abstract

Objective To investigate the effectiveness and safety of combined application of neuronavigation and yellow fluorescein-guided techniques in the treatment of brain gliomas. Methods A total of 37 cases of brain gliomas admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from March 2014 to March 2016 were enrolled into this retrospective study.All cases were divided into supratentorial (n=21) and brainstem (n=16) groups by location as well as adult (n=25) and child (n=12) groups by age. Fluorescein-guided surgery were conducted (5.0 mg/kg and 2.5 mg/kg of sodium fluorescein administered before dura opening in adult and child groups, respectively). Following the resection, the tumor boundary was evaluated with neuronavigation. Analysis was conducted about the consistency between neuronavigation and fluorescein-guided techniques. The patient’s KPS (Karnofsky performance status scale) was documented and analyzed at admission, discharge and 6-month follow-up. Results Among the total 25 adult cases, 23 reported satisfactory fluorescence results, while 11 out of 12 child cases reported satisfactory results. There were 5 cases showing non-consistency between yellow fluorescein enhancement and neuronavigation which included 4 from supratentorial group and 1 from brainstem group. Statistical analysis showed no significant differences in satisfactory rate of imaging between adult and child groups (P=0.704) and significant differences of consistency between supratentorial and brainstem groups (P=0.029). Total resection was achieved in 30 out of 37 cases. The average KPS at 6-month follow-up was significantly higher than that at admission(P=0.003). Conclusions The consistency between neuronavigation and fluorescein-guided technique seems to be higher in brainstem group than in supratentorial group. Half dose of sodium fluorescein (2.5 mg/kg) might be enough for pediatric patients. Combined uses of neuronavigation and yellow fluorescein-guided techniques could contribute to better clinical outcomes in patients of brain gliomas. Key words: Glioma; Neurosurgical procedures; Neuronavigation; Yellow fluorescein; Treatment outcome