Safety, efficacy, and side effects of sodium fluorescein-aided resection of glioblastoma: a quasi-experimental study.

Abstract

Background: The use of fluorescein sodium (FS) as a surgical adjunct in glioblastoma resection has shown promise in improving tumor visualization and resection outcomes. This study aimed to evaluate the safety, efficacy, and side effects of FS-aided resection in patients with glioblastoma.

Methods: This is a prospective, single-center cohort study conducted at Ibrahim Cardiac Hospital and Research Institute from September 2021 to November 2023. Twelve patients with histologically confirmed glioblastoma underwent FS-guided resection. All participants received an intravenous dose of FS (5 mg/kg body weight) ~30 min before surgery. The study follows a quasi-experimental design, focusing on the outcomes of FS-aided surgery without a control group. Patients were selected based on specific inclusion and exclusion criteria, and all surgeries were performed by a single experienced neurosurgeon. The extent of tumor resection was classified as gross total resection (GTR), near-total resection (NTR), or partial resection (PR).

Results: Gross total resection (GTR) was achieved in 66.6% of patients, near total resection (NTR) in 16.6%, and subtotal resection (STR) in 16.6%. No significant adverse effects were observed except for a single case of postoperative seizure, which was managed without long-term consequences. All patients showed normal liver and kidney function tests postoperatively. The low-dose FS protocol demonstrated both a high rate of GTR and a favorable safety profile, with only minor, transient side effects such as temporary yellow discoloration of the skin, sclera, and urine. No severe or long-term complications related to FS were observed during the follow-up period, which had a median duration of 13.4 months.

Conclusion: FS appears to be a safe and effective aid in glioblastoma resection, achieving high rates of GTR with minimal side effects. The findings suggest that FS, particularly at a low dose, is a viable, cost-effective alternative to other fluorescent markers, especially in settings where resource constraints may limit the use of more expensive options like 5-ALA.