Fluorescein-Guided Surgery for High-Grade Glioma Resection: A five-year long retrospective study in our institute

Abstract Objective: To investigate the outcomes and adverse events of glioma patients received surgery with or without fluorescein sodium guidance. Methods: A total of 136 patients who visited our hospital and underwent surgery from July 2017 to June 2022 were retrospectively analyzed. 75 cases in the fluorescein group, while 61 cases in the non-fluorescein group. Baseline characteristics, intraoperative blood loss, duration of operation and tumor mass resection were documented, adverse events were also recorded. Results: The duration of operation was significantly shorter in the fluorescein group than in the non-fluorescein group (P = 0.008), especially for patients with tumors in the frontal and occipital lobes (frontal, P = 0.036; occipital, P = 0.041). More critically, the rate of gross total resection (GTR) was significantly higher in the fluorescein group than in the non-fluorescein group (42.67% vs. 21.31%, P = 0.005), particularly for patients with tumors located in the temporal lobe, occipital lobe, and deep supratentorial area (temporal, 48.15% vs. 13.04%, P = 0.002; occipital, 53.84% vs. 0.00%, P = 0.026; deep supratentorial region, 15.00% vs. 5.88%, P = 0.016). however, there was no statistically significant difference in intraoperative blood loss (P = 0.094) or incidence of complications (6.67% vs. 4.92%, P = 0.668) between the two groups. Conclusions: Fluorescein-guided resection of high-grade gliomas using a dedicated filter on the operating microscope is feasible, safe, convenient and significantly increases the GTR rate; this is especially advantageous in patients with tumors located in non-verbal and motor areas such as the temporal and occipital lobes and deep supratentorial areas.