Abstract
Objectives: To explore the effectiveness and safety of the combined application of sodium fluorescein and neuronavigation techniques in the resection of brain gliomas in different locations and patients of different ages.Methods: Fifty clinical cases of brain gliomas treated at the Department of Neurosurgery of Beijing Tiantan Hospital were collected from March 2014 to March 2019. These cases were divided into a supratentorial group (24 cases) and a brainstem group (26 cases) based on location and an adult group (28 cases) and a pediatric group (22 cases) based on age. Fluorescein-guided surgery was performed: the adult group received 5 mg/kg sodium fluorescein before opening the dura, while the pediatric group received 2.5 mg/kg during resection. Tumor visualization was evaluated by the enhancement of yellow fluorescein and considered “satisfactory” if the illumination demarcated the tumor boundary. Additionally, the consistency between fluorescein and neuronavigation was analyzed. The Karnofsky performance score (KPS) of all patients was recorded and assessed at admission, discharge, and the 6-month follow-up.Results: In the 28 adult cases, 4 were unsatisfactory, while in the 22 pediatric cases, 2 were unsatisfactory; in 7 cases, there was an inconsistency between yellow fluorescein enhancement and neuronavigation, 6 were in the supratentorial group, and 1 was in the brainstem group. Statistical analysis showed no significant differences in the satisfactory rate between the adult and pediatric groups (P = 0.575), whereas there were significant differences inconsistency between the supratentorial group and brainstem group (P = 0.031). The mean KPS at admission was between 70 and 100, which was not significantly different from that at discharge (P = 0.839), but the KPS at the 6-month follow-up was significantly higher than that at admission (P = 0.041).Conclusions: The consistency between sodium fluorescein and the neuronavigation system was higher in the brainstem group than in the supratentorial group; a half dose of sodium fluorescein (2.5 mg/kg) was sufficient for pediatric patients. The combined utilization of sodium fluorescein and neuronavigation techniques may confer glioma patients the opportunity to obtain better clinical outcomes after surgery.
Highlights
Gliomas can occur in different locations and patients of different ages
Gross total resection (GTR) was defined as no residual tumors seen on postoperative MRI, near-total resection (NTR) was defined as
When comparing the consistency between fluorescein and neuronavigation, we found that the tumor margin distances measured independently by the two methods were not consistent in seven cases: six cases were from the supratentorial group and one from the brainstem group (Figure 2)
Summary
Gliomas can occur in different locations and patients of different ages. Many techniques made great contributions to tumor positioning and imaging, such as sodium fluorescein (FL), 5-aminolevulinic acid (5ALA), and neuronavigation, all of which resulted in much safer and more effective resection of brain gliomas, leading to better outcome to the patients [1,2,3]. Because of the diversity of anatomic structures in different intracranial areas, the accuracy and consistency of fluorescence and neuronavigation technology in different brain locations is still undetermined. It has been proven that 5 mg/kg sodium fluorescein is effective for demarcating the tumor margin in adults while 2.5 mg/kg is sufficient for pediatric patients, a comparative observation is still needed between adult and pediatric cases with different doses of sodium fluorescein to clarify the effect of imaging [4, 5]
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