Fluorescein Sodium-guided Resection Of Cerebral Malignant Glioma: A Clinical Study

Gliomas, which originated in the glial cells, are the most common primaryintracranial malignant tumors and becoming a rising trend in recent years, theyhave a high recurrence rate, morbidity, mortality rates and the low cure ratecharacteristics. Treatment of malignant glioma is still challenges inneurosurgery.The surgical treatment for gliomas complemented by radiotherapyand chemotherapy in comprehensive treatment programme is the maintreatment for malignant glioma at present. Clinical studies show that theprognosis for patients with malignant glioma is directly related to totalresection of the tumor for first time.But complete excision of tumors isdifficult,because malignant glioma invasive and the boundary is not clear,Howto judge the procedure intuitive in tumor tissue and excise tumors in thegreatest level is the premise and key to surgical treatment of malignantgliomas.Clinical application of the new technologies of fluorescence-guidedresection of glioma can significantly raise the total rate and improve theprognosis.Objective:The study was to explore the clinical application value of the fluoresceinsodium in resection of cerebral malignant glioma.Methods:The research organization randomizes40cases of imaging diagnosis forGlioma patients from April2011to February2012.The fluorescence-guidedsystem was used to resect the brain malignant gliomas in20cases, The tumorwas stained with sodium fluorescein and then resected after its border wasjudged based on the fluorescence staining intensity，and the other20patients with brain malignant glioma with traditional surgical resection. Count data usethe X~2test and measurement data use t test for statistical analysis,comparingthe two groups on total rate of tumor,KPS score, operation time and hospitalstay.Results:1. In fluorescein sodium-guided resection of glioma group,the extent ofglioma’s removal were consistent with histo-pathological examination.Postoperatively, imaging showed that the tumors were radically removed.2. The total tumor removal was achieved in17cases(85%)in fluoresceinsodium-guided resection of glioma group; while total tumor removal wasachieved in11cases(55%)in microsurgical resection of the traditional group,the total removal rate was much higher in fluorescein sodium-guided resectionof glioma group than the microsurgical resection of the traditionalgroup(P<0.05);In non-function area,the total removal rate was much higher influorescein sodium-guided resection of glioma group than the microsurgicalresection of the traditional group(P<0.05).3. In function area, The postoperative KPS scores was higher than thepreoperative KPS scores in fluorescein sodium-guided resection of gliomagroup(P<0.05);but there was no statistical difference in microsurgical resectionof the traditional group(P>0.05).4. The operation time and hospital stay of fluorescein sodium-guidedresection of glioma group were shorter than those of the microsurgicalresection of the traditional group (P=0.039and P=0.008).Conclusion:1. The new technologies of fluorescence-guided resection of gliomaincreases the total rate of cerebral malignant glioma, especially fornon-functional area glioma.2. For patients with brain malignant gliomas,the fluorescence-guided resection significantly improves KPS scores after surgery.3. The fluorescence-guided resection significantly reduces the operationtime and the hospital stay after surgery.