Clinical Study Of Fluorescein-guided Technique In Resection Of High-grade Gliomas

High grade glioma is the most common adult primary intracranial tumor,despite taking the combination therapy of surgery, chemotherapy andradiotherapy, the prognosis of patients is still not ideal. After combinedtreatment, anaplastic astrocytoma,5years survival rate is about28%, mediansurvival of glioblastoma multiforme only9-12months, most patients diedwithin2years and in recent years high grade glioma incidence rate showed atrend of increasing year by year. Its intractable, incidence, recurrence rate, highmortality rate and low cure rate are the common problems in Department ofneurosurgery. Previous retrospective studies and latest studies show that thedegree of tumor removal is significantly affected by the survival of patientswith these malignancies.. However, the aggressive growth of high-grade gliomais difficult to achieve the accurate distinction between tumor and normal tissuein the operation, and it can completely remove tumor.. Many new techniques,such as stereotactic stereotactic, intraoperative magnetic imaging andultrasound guidance, have been applied to surgery to improve surgical resectionrate.. The tumor tissue was stained by fluorescent material, and the tumorboundary was more accurate, and the tumor was the largest possible tumor. The fluorescein sodium guide this new technology has been popularization andapplication in the domestic and foreign many neurosurgical medical center andapplication reports confirmed fluorescein sodium guide application technologyto high grade gliomas surgery can help us to significantly improve the rate oftotal resection of tumor, improve the quality of life of patients and theprognosis.Objective:Evaluation of clinical efficacy of fluorescein-guided resection undermicrosurgical resection of high-grade gliomas.Methods:From2012September to2013September in our hospital, we put thepatients who was suspected newly diagnosed HGGs according to the pre-operative MRI and the tumor location allowing for complete resection areas determined by the surgeon after strict screening into the study group. I-naccordance with the group order, were randomly divided into two groups: fluorescein-guided microsurgical resection group and the traditional micro-scope under microsurgical resection group. If the postoperative pathologicalresults show that non high grade gliomas or other condition of entering thegroup conflict， to exclude the case. Count data, measurement data usingX~2test, t test was used for statistical analysis, comparing the two groupsof patients with total resection rate of patients, the rate of progression f-ree survivaland median survival period of PHS. Results:1. Fluorescein-guided group a total of28patients,6cases wereexcluded from the group, the actual group of22cases. The traditional operationgroup into a total group of28cases,7cases were excluded from the group, theactual group of21cases. The application of fluorescein sodium was found inpatients with adverse reactions of fluorescein sodium.2. In three days after the MRI examination, fluorescein sodium guidedgroup total resection of tumor in19cases (86.4%), the traditionalgroup operation complete resection in12cases (57.1%), two groups of the totalresection rate had significant difference (P<0.05).3. Fluorescein sodium guided group9month progression free survival ratewas77.2%, the median survival time was15months. The traditional group was9months survival rate of progression was57.1%, the median survival time was13months. Two groups of9months without significant difference in survivalrate (P<0.05), two median survival was significantly difference (P<0.05). Theno survival rate of6months of the fluorescein sodium guided group was77.2%,and the median survival time was12months. The progression free survival rateof6months of the traditional group was33.3%, and the median survival timewas10months..There was no difference in survival rate of the two groups at6months (P<0.05).Conclusion:1. The total resection rate of tumor can be improved by using fluoresceinsodium guided resection compared with the conventional microsurgery.2. Comparison of the operation of sodium fluorescein-guided andconventional microsurgery for Department of Neurosurgery，the effect was notsignificantly different from the preoperative and postoperative neurologicalfunction of patients.3. Sodium fluorescein guided high-grade gliomas resection can significantly prolong the progression free survival and survival of the patients.