Effect of Sodium Fluorescein Use on Surgical Outcomes and Survival in Cases with High Graded Glial Tumor : A retrospective study

Abstract

Abstract Objective: The most effective factor on malignant glioma (MGs) treatment affecting the overall survival is the extent of resection (EOR). The use of sodium fluorescein (FL) staining in order to increase the amount of resection, is applied more effectively and safely at lower doses with the aid of 560nm filtered surgical microscopes. It was planned to investigate the effects of the use of FL in MGs surgery on the gross total resection rate (GTR), duration of surgery, length of hospital stay, and survival time. Material Method: The follow-up of 17 patients whose histopathological evaluations were reported as MGs and operated under surgical white light, and 23 patients who were operated under FL560 module surgical microscope with low dose of (3mg/kg bodyweight) FL dye were evaluated for three years retrospectively. The blood loss in the course of surgery, GTR, surgical time, hospital stay were compared for both groups with Student-t test or Mann-Whitney U test. Kaplan-Meier method was used for the survival time analysis. Results: While GTR rates were found out to be %82.3 for patients operated under surgical white light, the percentage for FL utilized patients was %91.3. There was no significant difference in blood loss or hospital stay between the two groups; however the surgical time for FL utilized patients were found out to be significantly low in comparison to the other group. The overall survival time for patients who were operated under surgical white light was found out to be 64 weeks (448 ± 64 days) while it was determined as 84.7 weeks (593±55 days) for patients operated with the use of FL, however the difference between them was not found out to be statistically significant. The use of FL enabled the surgeon to determine the cortical incision area in 13 cases, where the location of the tumor was close to the cortex. Conclusion: While the use of FL shortens the surgical time in contrast-enhancing MGs, it increases the GTR rate. FL also functions well with the determination of the location of surgical site for tumors close to the cortex.