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Fluorescein-guided Surgery for High Grade Glioma Resection: an Intraoperative "Contrast-enhancer".
World Neurosurg. 2017 May 13;:
Authors: Catapano G, Sgulò FG, Seneca V, Lepore G, Columbano L, di Nuzzo G
Abstract
BACKGROUND: Fluorescein sodium salt is widely used in medicine as fluorescein isothiocyanate and commonly named fluorescein (FL). This fluorophore has been used as a fluorescent tracer for many applications, especially in ophthalmic surgery. The initial use in neuro-oncologic field occurred in 1948 in order to control tumor resection margins. After a transient disuse, it has recently had a second spring with the development of dedicated filters for operating microscope, although it is still under evaluation in clinical use. The aim of this study is to contribute to the investigation according to which FL-guided surgery for high grade glioma (HGG) is related to better rates of gross total resection (GTR) and so to a better outcome.
MATHERIALS AND METHODS: We retrospectively analyzed 23 cases of patients with new diagnosis of HGG, operated at our Unit by intraoperative FL-use with a filter system directly integrated into operative microscope (group 1). Fluorescence was compared with histology by biopsies carried out both in the fluorescent areas and in the periphery of fluorescent areas. Group 1 was matched with a control group of 25 patients with HGG operated at our Unit during the last two years without FL-guidance (group 2).
RESULTS: No side effects related to FL occurred. Histology and intraoperative neuronavigation showed strong correspondence with fluorescent and non-fluorescent areas. GTR rate was significantly higher in group 1 (82.6%) than group 2 (52%).
CONCLUSIONS: Intraoperative fluorescein-guided surgery showed safety and feasibility. Our and other studies suggest an improvement of GTR rate in HGG than nonuse.
PMID: 28512039 [PubMed - as supplied by publisher]
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