Effect of Sodium Fluorescein Use on Surgical Outcomes and Survival in Cases with High Graded Glial Tumor : A retrospective study

Abstract

Objective: The most effective factor on malignant glioma (MGs) treatment affecting overall survival is the extent of resection. The use of sodium fluorescein (FL) staining in order to increase the amount of resection, is applied more effectively and safely at lower doses with the aid of 560nm filtered surgical microscopes. Our aim was to investigate the effects of the use of FL in MGs surgery on the gross total resection rate (GTR), duration of surgery, length of hospital stays, and survival time.Methods: A retrospective study was conducted on 17 patients whose histopathological evaluations were reported as MGs and operated under surgical white light (Group 1), and 23 patients who were operated under FL560 module surgical microscope (Group 2) with a low dose of (3mg/kg body weight) FL dye. The blood loss in the course of surgery, GTR, surgical time, and hospital stay were compared for both groups with the student-t-test. Kaplan-Meier method was used for the survival time analysis.Results: GTR rates were found to be 82.3% for patients operated under surgical white light, and the percentage for FL-utilized patients was 91.3%. There was no significant difference in blood loss or hospital stay between the two groups; however, the surgical time for FL-utilized patients was found to be significantly low in comparison to the other group. The overall survival time for patients who were operated under surgical white light was found to be 64 weeks (448 ± 64 days) while it was determined as 84.7 weeks (593±55 days) for patients operated with the use of FL, however, the difference between them was not found out to be statistically significant. The use of FL enabled the surgeon to determine the cortical incision area in 13 cases, where the location of the tumor was close to the cortex.Conclusions: While the use of FL shortens the surgical time in contrast-enhancing MGs, it increases the GTR rate. FL also functions well with the determination of the location of the surgical site for tumors close to the cortex.