title: Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases.
abstract: BACKGROUND
  Fluorescein is widely used as a fluorescent tracer for many applications. Its capability to accumulate in cerebral areas with blood-brain barrier damage makes it an ideal dye for intraoperative visualization of malignant gliomas (MG). We report our preliminary experience in fluorescein-guided removal of grade IV gliomas using a dedicated filter on the surgical microscope.
  
  
  METHODS
  In September 2011 we started a prospective phase II trial (FLUOGLIO) to evaluate the safety and obtain initial indications about the efficacy of fluorescein-guided surgery for MG. Patients with suspected MG amenable to complete resection of contrast-enhancing areas were eligible to participate in this study. This report is based on a preliminary analysis of the results of 12 patients with grade IV gliomas out of 15 consecutive cases (age range 48-72 years) enrolled since September 2011. Fluorescein was injected intravenously (i.v.) after intubation (5-10 mg/kg). The tumor was removed using a microsurgical technique and fluorescence visualization by BLU 400 or YELLOW 560 filters on a Pentero microscope (Carl Zeiss, Germany). The study was approved by our ethics committee and registered on the European Regulatory Authorities website (EudraCT no. 2011-002527-18).
  
  
  RESULTS
  Histological analysis confirmed grade IV gliomas in 12/15 cases. Median preoperative tumor volume was 33.15 cm(3) (9.6-87.8 cm(3)). No adverse reaction related to the administration of fluorescein was registered. Contrast-enhanced tumor was completely removed in 75 % of the patients.
  
  
  CONCLUSIONS
  This preliminary analysis suggested that the use of intravenous fluorescein during surgery on grade IV gliomas is safe and allows a high rate of complete resection of contrast-enhanced tumor at the early postoperative MRI.
authors: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. acerbi.f@istituto-besta.it
authors: Francesco
authors: F
authors: Acerbi
authors: Morgan
authors: M
authors: Broggi
authors: Marica
authors: M
authors: Eoli
authors: Elena
authors: E
authors: Anghileri
authors: Lucia
authors: L
authors: Cuppini
authors: Bianca
authors: B
authors: Pollo
authors: Marco
authors: M
authors: Schiariti
authors: Sergio
authors: S
authors: Visintini
authors: Chiara
authors: C
authors: Orsi
authors: Angelo
authors: A
authors: Franzini
authors: Giovanni
authors: G
authors: Broggi
authors: Paolo
authors: P
authors: Ferroli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D005910:Glioma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein