Fluorescein sodium for resection of high-grade astrocytoma: A single-center prospective study in Vietnam

Abstract

Objective

The objective of this study was to assess the feasibility, safety, and efficacy of using fluorescein sodium (FS) with the YELLOW 560 nm filter as an adjunct in the resection of high-grade astrocytomas.

Methods

Between October 2019 and October 2023, 62 patients diagnosed with high-grade astrocytoma were prospectively enrolled. Thirty-two patients underwent FS-guided microsurgical resection using a YELLOW 560 nm filter (Group I), and 30 patients underwent standard white-light microsurgical resection (Group II). FS was administered intravenously at a dose of 5–10 mg/kg prior to anesthesia induction. All patients underwent postoperative neurological evaluations and MRI at 72 h, and at 6 and 12 months. The primary endpoint was the accuracy of FS in delineating tumor margins via intraoperative biopsies. Secondary endpoints included extent of resection (EOR) and perioperative safety.

Results

Group I was further stratified into Subgroup 1 (non-eloquent area tumors, n = 24) and Subgroup 2 (tumors adjacent to eloquent cortex, n = 8). Mean preoperative tumor volume was 40.97 cm³ in Subgroup 1 and 53.78 cm³ in Subgroup 2. GTR was achieved in 83.3 % of Subgroup 1 but not in Subgroup 2 (mean EOR: 87.47 %). In Group II, 43.3 % achieved GTR. Subgroup 1 showed significantly higher GTR rates than Group II (p = 0.0045). FS-guided margin delineation showed sensitivity of 80.95 %, specificity of 91.48 %, and positive predictive value of 92.72 % across 110 tissue samples. No serious adverse events were noted, except for transient yellow urine discoloration.

Conclusions

FS with the YELLOW 560 nm filter is a safe and effective intraoperative tool that enhances tumor visualization and supports maximal safe resection in high-grade astrocytoma surgery, particularly in non-eloquent regions.