Effects Of Fluorescein Sodium Combined With Multi-modality Neuronavigation In Surgical Treatment Of Intracranial Gliomas

Background: Intracranial malignant tumors account for about 2.66% of all tumors,ranking ninth in all malignant tumors.Glioma ranks first among intracranial malignancies,which can be diagnosed by medical imaging method such as cranial magnetic resonance.The most important step in the treatment of intracranial gliomas is microsurgical resection.While its rate of resection depends on location and malignancy of tumors.Under the condition of ensuring life safety and function preservation,tumors should be removed as much as possible,.Purpose: Intracranial gliomas often exceed the range shown by the preoperative MRI T1 enhancement,due to its infiltration and malignancy.It is very difficult to achieve gross total resection.The neuronavigation system is a widely used neurosurgery auxiliary equipment,which can establish a three-dimensional model based on preoperative and intraoperative imaging data,providing guidance for neurosurgeons.In recent years,advancement of computer performance emerges advancement in neuronavigation systems.Now,newest type of neuronavigation system is capable of processing a fusion of multiple imaging sets,including PET/DTI/CTA etc,which is known as multimodal neuronavigation system.Sodium fluorescein is a fluorescent dye that can penetrate the damaged blood-brain barrier and accumulate in the interstitium of tumor cells.It can emit yellow-green light when irradiated with light of a specific wavelength,which offers assistance to neurosurgeons in tumor resection.Therefore,this study intends to analyze two groups of different patients who received fluorescein sodium combined with multimodal neuronavigation tumor resection or neuronavigation only.Rate of tumor resection,KPS score,survival rate and other indicators will be analyzed.Method:70 cases of intracranial glioma patients who underwent surgical treatment for glioma in neuro-oncology department of Shiyan Taihe Hospital from November2018 to December 2019 were enrolled.49 cases meets the criteria.Patients were divided into 2groups: fluorescent neuronavigation group(n=26)and neuronavigation group(n=23)according to sodium fluorescein usage.Baseline information included age,tumor location,tumor volume,preoperative KPS score,etc.Comparing the pre and post op MRI data,tumor volume and rate of GTR was calculated.1-month KPS score and recurrence of the patients were achieved by telephone follow-up.All data were analyzed using SPSS 19.0 statistical software,the measurement data were compared by t test,the classification data was by X2 test,and P<0.05 was considered statistically significant.WPS 2019 is used for drawing and tabulation.Results: The baseline characteristics of the two groups of patients,gender,age,tumor location(functional or non-functional areas),tumor volume,preoperative KPS,tumor grade,etc.Didn’t achieve significant difference.In the intraoperative fluorescent navigation group,Strong fluorescence was observased in 22 cases,including 18high-grade gliomas and 4 low-grade gliomas,with 4 low-grade glioma unsatisfactory.During the operation,all cases had more or less neuronavigation drift.The rate of gross total resection;1month-KPS;status of recurrence in the fluorescent navigation group was batter than that in the navigation group.Conclusion: Combination of fluorescein sodium and multimodal neuronavigation can improve the rate of total tumor resection;KPS score;status of recurrence.Therefore,fluorescein sodium combined with multimodal neuronavigation tumor resection can improve the efficacy of surgical treatment of intracranial gliomas.