Comparison of sodium fluorescein and sodium fluorescein with intraoperative ultrasonography Efficacy in glioblastoma resection

Background

This study investigated the effectiveness of intraoperative ultrasonography (IOUS) combined with sodium fluorescein (SF) in evaluating tumor resection completeness in patients with glioblastoma IDH1-wildtype. By comparing SF with IOUS with postoperative magnetic resonance imaging (MRI) for detecting residual tumors, we aimed to evaluate its potential in improving surgical precision and neurosurgical outcomes.

Methods

Adult patients with supratentorial IDH-wildtype grade 4 glioblastoma who underwent resection using SF or SF with IOUS during 2015–2024 were included.

Results

A total of 97 patients met the inclusion criteria (49 SF group and 48 SF with IOUS group). The gross total resection (GTR) rate was higher in the SF with IOUS group (83.3 %) than in the SF group (67.3 %), although the difference was not statistically significant (p = 0.112). For residual tumors according to postoperative MRI findings as a result of subtotal resection due to tumor invasion of eloquent anatomical locations, 6/49 (12.2 %) patients in the SF group showed a positive result (ϰ: 0.447, p = 0.001), and 4/48 (8.3 %) patients in the SF with IOUS group showed a positive result (ϰ: 0.625, p < 0.001). The sensitivity, specificity, negative predictive value, and positive predictive value for predicting residual tumors peroperatively compared with postoperative MRI results were calculated for the SF and SF with IOUS groups. Comparison between the SF and SF with IOUS groups revealed a statistically significant difference in the estimated mean survival time, with 14 months (standard error: 1.236) for the SF group and 24 months (standard error: 4.103) for the SF with IOUS group (p < 0.001). In total, 11/49 (22.4 %) patients in the SF group, and 10/48 (20.8 %) patients in the SF with IOUS group experienced newly developed neurological deficits postoperatively (p > 0.05). In the SF with IOUS group, 26/48 (54.2 %) patients, 14/48 (29.2 %) patients, and 8/48 (16.7 %) patients had Karnofsky Performance Status scores of 90–100, 70–80, and < 70, respectively (p = 0.525), and 12 patients experienced deterioration, 24 patients were stable, and 12 patients had improved at 1 month.

Conclusions

SF with IOUS provides a reliable imaging modality for achieving successful GTR and improving surgical outcomes. Nevertheless, further research is necessary to overcome its limitations and better define its intraoperative role.