title: Gross total resection of glioma with the intraoperative fluorescence-guidance of fluorescein sodium.
abstract: OBJECTIVE
  High dose fluorescein sodium has been utilized for fluorescence-guided tumor resection with conflicting reports on the efficacy of this procedure. The aim of this study was to reevaluate the utility and clinical limitations of using fluorescein sodium for the treatment and resection of glioma brain tumors.
  
  
  METHODS
  Patients diagnosed with glioma were divided into two groups with a total of 22 patients enrolled in the study: 1) the study group (n=10), patients that received intravenous injection of fluorescein sodium and 2) the control group (n=12), patients that did not receive injections during surgical resection. Quality of life was evaluated according to Karnofsky Performance Scale (KPS) score and neurological status. Fluorescein sodium was intravenously injected at a dose of 15-20mg/kg of body weight. Glioma resection was evaluated preoperative and postoperatively with enhanced Magnetic Resonance Imaging (MRI).
  
  
  RESULTS
  Significant differences in the gross total resection (GTR) rates were observed between the two patient groups (Fisher's Exact Test p=0.047). Progressive free survival was significantly longer in the study group (Student's T-Test p=0.033) as well as in the GTR group (Student's T-Test p=0.0001) compared to the control and non-GTR groups, respectively. Three patients in the study group and four patients in the control group had transient neurological deterioration. One patient in the control group had permanent hemiplegia.
  
  
  CONCLUSIONS
  The intraoperative utility of using fluorescein sodium can significantly increase the GTR rate without obvious deterioration. In addition, we find that it is better to apply the fluorescein sodium in the cases with BBB (blood-brain barrier) disruption, which had been enhanced in preoperative MRI.
authors.affiliation: Department of neurosurgery The First Hospital of Jilin University, Changchun, Jilin 130021, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Chen
authors.forename: Haifeng
authors.initials: H
authors.lastname: Wang
authors.forename: Pengfei
authors.initials: P
authors.lastname: Ge
authors.forename: Jingwei
authors.initials: J
authors.lastname: Zhao
authors.forename: Wenchen
authors.initials: W
authors.lastname: Li
authors.forename: Huizi
authors.initials: H
authors.lastname: Gu
authors.forename: Guangming
authors.initials: G
authors.lastname: Wang
authors.forename: Yinan
authors.initials: Y
authors.lastname: Luo
authors.forename: Dawei
authors.initials: D
authors.lastname: Chen
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D019793:Fluorescein; D005910:Glioma / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged
chemical_list: D019793:Fluorescein
keywords: fluorescein sodium; glioma; gross-total resection; neurosurgery