Evaluation of the effect of fluorescein sodium-guided under yellow 560nm surgical microscope filter in surgery for high grade gliomas: Preliminary results in a series of 27 patients

Abstract

Objective: The importance of a complete resection of high‑grade gliomas (HGGs) has been highlighted in scientific literature, in order to limit tumor recurrence and above all to improve disease‑free survival rates. Several fluorescent biomarkers have been tested to improve intraoperative identification of residual tumor. The fluorescein sodium (FS) are now starting to play an important role in glioma surgery. Under the YELLOW 560nm surgical microscope filter, low-dose FS (5mg/kg) as a fluorescent dye helps in visualization of tumor tissue. Our study provides preliminary results in investigating the safety and efficacy of this technique in patients with HGGs. Subject and method: A prospective, uncontrolled study of 27 patients with HGGs underwent FS-guided resection under YELLOW 560nm surgical microscope filter. We have analyzed the clinical features, size, tumor location, extent of tumor resection, pathologic of HGGs, patient status (Karnofsky Performance Scale) and FS side effects. Result: 7/27 patients (25.9%) were glioma grade III and 20/27 patients (74.1%) were glioma multiforme (GBM). With YELLOW 560nm surgical microscope filter (PENTERO 900 surgical microscope), FS-guided gross total resection (GTR) was achieved in 74.1% and subtotal resection (STR) in 11.1%. No side effects of FS were reported. Conclusion: FS-guided resection of HGGs under the YELLOW 560nm surgical microscope filter was effective and safe.