Is fluorescein-guided technique able to help in resection of high-grade gliomas?
OBJECTIVE
Fluorescein, a dye that is widely used as a fluorescent tracer, accumulates in cerebral areas where the blood-brain barrier is damaged. This quality makes it an ideal dye for the intraoperative visualization of high-grade gliomas (HGGs). The authors report their experience with a new fluorescein-guided technique for the resection of HGGs using a dedicated filter on the surgical microscope.


METHODS
The authors initiated a prospective Phase II trial (FLUOGLIO) in September 2011 with the objective of evaluating the safety of fluorescein-guided surgery for HGGs and obtaining preliminary evidence regarding its efficacy for this purpose. To be eligible for participation in the study, a patient had to have suspected HGG amenable to complete resection of the contrast-enhancing area. The present report is based on the analysis of the short- and long-term results in 20 consecutive patients with HGGs (age range 45-74 years), enrolled in the study since September 2011. In all cases fluorescein (5-10 mg/kg) was injected intravenously after intubation. Tumor resection was performed with microsurgical technique and fluorescence visualization by means of BLUE 400 or YELLOW 560 filters on a Pentero microscope.


RESULTS
The median preoperative tumor volume was 30.3 cm(3) (range 2.4-87.8 cm(3)). There were no adverse reactions related to fluorescein administration. Complete removal of contrast-enhanced tumor was achieved in 80% of the patients. The median duration of follow-up was 10 months. The 6-months progression-free survival rate was 71.4% and the median survival was 11 months.


CONCLUSIONS
Analysis of these 20 cases suggested that fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows a high rate of complete resection of contrast-enhanced tumor as determined on early postoperative MRI. Clinical trial registration no.: 2011-002527-18 (EudraCT).
Departments of Neurosurgery.
Francesco
F
Acerbi
Morgan
M
Broggi
Marica
M
Eoli
Elena
E
Anghileri
Claudio
C
Cavallo
Carlo
C
Boffano
Roberto
R
Cordella
Lucia
L
Cuppini
Bianca
B
Pollo
Marco
M
Schiariti
Sergio
S
Visintini
Chiara
C
Orsi
Emanuele
E
La Corte
Giovanni
G
Broggi
Paolo
P
Ferroli
D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
D005456:Fluorescent Dyes; D019793:Fluorescein