Sodium Fluorescein Guided Excision of High Grade Gliomas: A Tool for Total Excision

Abstract
Background: The best management of high grade gliomas starts with adequate cytoreductive surgery followed by adjuvant therapies. The extent of tumor resection is an important prognostic factor, and it directly affects the tumor progression and the median survival period. Sodium Fluorescein is a fluorescent tracer that crosses the disrupted blood brain barrier, making it suitable for intraoperative visualization of malignant gliomas.
Aim: To evaluate the effectiveness of Na Fluorescein to demarcate tumor tissue from brain tissue.
Material and Methods: This study was conducted on 30 patients who were indicated for surgical excision of radiolog-ically diagnosed high grade gliomas. All cases had pre and immediate post-operative imaging with contrast to detect the amount of tumor excision. In all our cases at the time of opening the dura, after doing sensitivity testing, 15-20mg/Kg Na Fluorescein was administrated intravenously. The visible yellow stained tumor was then excised using the standard microscopic procedure.
Results: All cases had primary brain gliomas (21 were WHO grade IV and 9 cases were grade III). Post-operative imaging showed gross total excision in 23 cases (77%), near total excision (>80% of tumor removed) in 6 cases (20%), and subtotal excision (<80% of tumor removed) in 1 case (3%). None of our cases showed any complications related to reaction from Fluorescein, while 2 cases (6.7%) had transient post-operative motor weakness, and 1 case (3%) had postop-erative dysphasia.
Conclusion: The use of Sodium Fluorescein has proven to be an effective tool for demarcation of tumoral tissue from brain tissue; this demarcation was evident using the naked eye, as well as the non-filtered white microscopic light. It is a simple, safe technique, and can be used in economically limited centers; in which Neuronavigation isn't available. The use of Fluorescein increases the chances of safe gross total excision of high grade gliomas, which is reflected on increasing the survival rates as well as decreasing the tumor progression.