Utility of sodium fluorescein for achieving resection targets in glioblastoma: increased gross- or near-total resections and prolonged survival

Restricted access

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

 

OBJECTIVE

It is commonly reported that achieving gross-total resection of contrast-enhancing areas in patients with glioblastoma (GBM) improves overall survival. Efforts to achieve an improved resection have included the use of both imaging and pharmacological adjuvants. The authors sought to investigate the role of sodium fluorescein in improving the rates of gross-total resection of GBM and to assess whether patients undergoing resection with fluorescein have improved survival compared to patients undergoing resection without fluorescein.

METHODS

A retrospective chart review was performed on 57 consecutive patients undergoing 64 surgeries with sodium fluorescein to treat newly diagnosed or recurrent GBMs from May 2014 to June 2017 at a teaching institution. Outcomes were compared to those in patients with GBMs who underwent resection without fluorescein.

RESULTS

Complete or near-total (≥ 98%) resection was achieved in 73% (47/64) of fluorescein cases. Of 42 cases thought not to be amenable to complete resection, 10 procedures (24%) resulted in gross-total resection and 15 (36%) resulted in near-total resection following the use of sodium fluorescein. No patients developed any local or systemic side effects after fluorescein injection. Patients undergoing resection with sodium fluorescein, compared to the non–fluorescein-treated group, had increased rates of gross- or near-total resection (73% vs 53%, respectively; p < 0.05) as well as improved median survival (78 weeks vs 60 weeks, respectively; p < 0.360).

CONCLUSIONS

This study is the largest case series to date demonstrating the beneficial effect of utilizing sodium fluorescein as an adjunct in GBM resection. Sodium fluorescein facilitated resection in cases in which it was employed, including dominant-side resections particularly near speech and motor regions. The cohort of patients in which sodium fluorescein was utilized had statistically significantly increased rates of gross- or near-total resection. Additionally, the fluorescein group demonstrated prolonged median survival, although this was not statistically significant. This work demonstrates the promise of an affordable and easy-to-implement strategy for improving rates of total resection of contrast-enhancing areas in patients with GBM.

ABBREVIATIONS BBB = blood-brain barrier; EOR = extent of resection; GBM = glioblastoma; GTR = gross-total resection; IDH-1 = isocitrate dehydrogenase–1; MGMT = O6-methylguanine–DNA methyltransferase; NTR = near-total resection; OR = odds ratio; STR = subtotal resection; 5-ALA = 5-aminolevulinic acid.
Article Information

Contributor Notes

Correspondence Gennadiy A. Katsevman: West Virginia University, Morgantown, WV. gkatsev@gmail.com.INCLUDE WHEN CITING Published online February 8, 2019; DOI: 10.3171/2018.10.JNS181174.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Acerbi F: Fluorescein assistance in neuro-oncological surgery: a trend of the moment or a real technical adjunt? Clin Neurol Neurosurg 144:1191202016

    • Search Google Scholar
    • Export Citation
  • 2

    Acerbi FBroggi MBroggi GFerroli P: What is the best timing for fluorescein injection during surgical removal of high-grade gliomas? Acta Neurochir (Wien) 157:137713782015

    • Search Google Scholar
    • Export Citation
  • 3

    Acerbi FBroggi MEoli MAnghileri ECavallo CBoffano C: Is fluorescein-guided technique able to help in resection of high-grade gliomas? Neurosurg Focus 36(2):E52014

    • Search Google Scholar
    • Export Citation
  • 4

    Acerbi FBroggi MEoli MAnghileri ECuppini LPollo B: Fluorescein-guided surgery for grade IV gliomas with a dedicated filter on the surgical microscope: preliminary results in 12 cases. Acta Neurochir (Wien) 155:127712862013

    • Search Google Scholar
    • Export Citation
  • 5

    Acerbi FCavallo CBroggi MCordella RAnghileri EEoli M: Fluorescein-guided surgery for malignant gliomas: a review. Neurosurg Rev 37:5475572014

    • Search Google Scholar
    • Export Citation
  • 6

    Barbosa BJAPMariano EDBatista CMMarie SKNTeixeira MJPereira CU: Intraoperative assistive technologies and extent of resection in glioma surgery: a systematic review of prospective controlled studies. Neurosurg Rev 38:2172272015

    • Search Google Scholar
    • Export Citation
  • 7

    Behbahaninia MMartirosyan NLGeorges JUdovich JAKalani MYSFeuerstein BG: Intraoperative fluorescent imaging of intracranial tumors: a review. Clin Neurol Neurosurg 115:5175282013

    • Search Google Scholar
    • Export Citation
  • 8

    Bloch OHan SJCha SSun MZAghi MKMcDermott MW: Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg 117:103210382012

    • Search Google Scholar
    • Export Citation
  • 9

    Chaichana KLJusue-Torres INavarro-Ramirez RRaza SMPascual-Gallego MIbrahim A: Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. Neuro Oncol 16:1131222014

    • Search Google Scholar
    • Export Citation
  • 10

    Craig SELWright JSloan AEBrady-Kalnay SM: Fluorescent-guided surgical resection of glioma with targeted molecular imaging agents: a literature review. World Neurosurg 90:1541632016

    • Search Google Scholar
    • Export Citation
  • 11

    Delgado-López PDCorrales-García EM: Survival in glioblastoma: a review on the impact of treatment modalities. Clin Transl Oncol 18:106210712016

    • Search Google Scholar
    • Export Citation
  • 12

    Dilek OIhsan ATulay H: Anaphylactic reaction after fluorescein sodium administration during intracranial surgery. J Clin Neurosci 18:4304312011

    • Search Google Scholar
    • Export Citation
  • 13

    Ewelt CNemes ASenner VWölfer JBrokinkel BStummer W: Fluorescence in neurosurgery: its diagnostic and therapeutic use. Review of the literature. J Photochem Photobiol B 148:3023092015

    • Search Google Scholar
    • Export Citation
  • 14

    Grabowski MMRecinos PFNowacki ASSchroeder JLAngelov LBarnett GH: Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg 121:111511232014

    • Search Google Scholar
    • Export Citation
  • 15

    Hadjipanayis CGWidhalm GStummer W: What is the surgical benefit of utilizing 5-aminolevulinic acid for fluorescence-guided surgery of malignant gliomas? Neurosurgery 77:6636732015

    • Search Google Scholar
    • Export Citation
  • 16

    Hamamcıoğlu MKAkçakaya MOGöker BKasımcan Kırış T: The use of the YELLOW 560 nm surgical microscope filter for sodium fluorescein-guided resection of brain tumors: our preliminary results in a series of 28 patients. Clin Neurol Neurosurg 143:39452016

    • Search Google Scholar
    • Export Citation
  • 17

    Koc KAnik ICabuk BCeylan S: Fluorescein sodium-guided surgery in glioblastoma multiforme: a prospective evaluation. Br J Neurosurg 22:991032008

    • Search Google Scholar
    • Export Citation
  • 18

    Li YRey-Dios RRoberts DWValdés PACohen-Gadol AA: Intraoperative fluorescence-guided resection of high-grade gliomas: a comparison of the present techniques and evolution of future strategies. World Neurosurg 82:1751852014

    • Search Google Scholar
    • Export Citation
  • 19

    Li YMSuki DHess KSawaya R: The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection? J Neurosurg 124:9779882016

    • Search Google Scholar
    • Export Citation
  • 20

    Liu JGYang SFLiu YHWang XMao Q: Magnetic resonance diffusion tensor imaging with fluorescein sodium dyeing for surgery of gliomas in brain motor functional areas. Chin Med J (Engl) 126:241824232013

    • Search Google Scholar
    • Export Citation
  • 21

    Liu JTCMeza DSanai N: Trends in fluorescence image-guided surgery for gliomas. Neurosurgery 75:61712014

  • 22

    Martirosyan NLEschbacher JMKalani MYSTurner JDBelykh ESpetzler RF: Prospective evaluation of the utility of intraoperative confocal laser endomicroscopy in patients with brain neoplasms using fluorescein sodium: experience with 74 cases. Neurosurg Focus 40(3):E112016

    • Search Google Scholar
    • Export Citation
  • 23

    Montemurro NPerrini PBlanco MOVannozzi R: Second surgery for recurrent glioblastoma: a concise overview of the current literature. Clin Neurol Neurosurg 142:60642016

    • Search Google Scholar
    • Export Citation
  • 24

    Neira JAUng THSims JSMalone HRChow DSSamanamud JL: Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance. J Neurosurg 127:1111222017

    • Search Google Scholar
    • Export Citation
  • 25

    Okuda TKataoka KYabuuchi TYugami HKato A: Fluorescence-guided surgery of metastatic brain tumors using fluorescein sodium. J Clin Neurosci 17:1181212010

    • Search Google Scholar
    • Export Citation
  • 26

    Okuda TYoshioka HKato A: Fluorescence-guided surgery for glioblastoma multiforme using high-dose fluorescein sodium with excitation and barrier filters. J Clin Neurosci 19:171917222012

    • Search Google Scholar
    • Export Citation
  • 27

    Oppenlander MEWolf ABSnyder LABina RWilson JRCoons SW: An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity. J Neurosurg 120:8468532014

    • Search Google Scholar
    • Export Citation
  • 28

    Orringer DLau DKhatri SZamora-Berridi GJZhang KWu C: Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival. J Neurosurg 117:8518592012

    • Search Google Scholar
    • Export Citation
  • 29

    Oszvald AGüresir ESetzer MVatter HSenft CSeifert V: Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age. J Neurosurg 116:3573642012

    • Search Google Scholar
    • Export Citation
  • 30

    Rey-Dios RCohen-Gadol AA: Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. Acta Neurochir (Wien) 155:7017062013

    • Search Google Scholar
    • Export Citation
  • 31

    Rey-Dios RHattab EMCohen-Gadol AA: Use of intraoperative fluorescein sodium fluorescence to improve the accuracy of tissue diagnosis during stereotactic needle biopsy of high-grade gliomas. Acta Neurochir (Wien) 156:107110752014

    • Search Google Scholar
    • Export Citation
  • 32

    Sanai NPolley MYMcDermott MWParsa ATBerger MS: An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115:382011

    • Search Google Scholar
    • Export Citation
  • 33

    Schebesch KMHoehne JHohenberger CProescholdt MRiemenschneider MJWendl C: Fluorescein sodium-guided resection of cerebral metastases—experience with the first 30 patients. Acta Neurochir (Wien) 157:8999042015

    • Search Google Scholar
    • Export Citation
  • 34

    Schebesch KMProescholdt MHöhne JHohenberger CHansen ERiemenschneider MJ: Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery—a feasibility study. Acta Neurochir (Wien) 155:6936992013

    • Search Google Scholar
    • Export Citation
  • 35

    Schucht PSeidel KBeck JMurek MJilch AWiest R: Intraoperative monopolar mapping during 5-ALA-guided resections of glioblastomas adjacent to motor eloquent areas: evaluation of resection rates and neurological outcome. Neurosurg Focus 37(6):E162014

    • Search Google Scholar
    • Export Citation
  • 36

    Schwake MStummer WSuero Molina EJWölfer J: Simultaneous fluorescein sodium and 5-ALA in fluorescence-guided glioma surgery. Acta Neurochir (Wien) 157:8778792015

    • Search Google Scholar
    • Export Citation
  • 37

    Shinoda JYano HYoshimura SOkumura AKaku YIwama T: Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note. J Neurosurg 99:5976032003

    • Search Google Scholar
    • Export Citation
  • 38

    Stummer W: Fluorescein for vascular and oncological neurosurgery. Acta Neurochir (Wien) 155:147714782013

  • 39

    Stummer W: Fluorescein in brain metastasis and glioma surgery. Acta Neurochir (Wien) 157:219922002015

  • 40

    Stummer W: Poor man’s fluorescence? Acta Neurochir (Wien) 157:137913812015

  • 41

    Stummer WPichlmeier UMeinel TWiestler ODZanella FReulen HJ: Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:3924012006

    • Search Google Scholar
    • Export Citation
  • 42

    Stupp RMason WPvan den Bent MJWeller MFisher BTaphoorn MJ: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:9879962005

    • Search Google Scholar
    • Export Citation
  • 43

    Su XHuang QFChen HLChen J: Fluorescence-guided resection of high-grade gliomas: a systematic review and meta-analysis. Photodiagn Photodyn Ther 11:4514582014

    • Search Google Scholar
    • Export Citation
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 130 130 94
Full Text Views 29 29 12
PDF Downloads 62 62 36
EPUB Downloads 0 0 0
PubMed
Google Scholar