Pediatric Low-Grade Glioma Surgery with Sodium Fluorescein: Efficient Localization for Removal and Association with Intraoperative Pathological Sampling

Abstract

Low-grade gliomas are among the most common CNS lesions in pediatrics and surgery is often the first-line treatment. Intraoperative tools have been developed to maximize the results of surgery, and in particular dyes such as sodium fluorescein (SF) have been investigated in high-grade adult lesions. The use of SF in pediatric low-grade gliomas is still unclear. We retrospectively reviewed 22 pediatric CNS low-grade gliomas operated on with SF from September 2021 to October 2022. A total of 86% of lesions showed SF uptake, which was helpful intraoperatively (confirmation of initial localization of the tumor, or identification of tumor remnants) in 74% of them. The intraoperative fluorescence seems associated with gadolinium enhancement at the preoperative MRI. Interestingly, the extemporaneous pathological sampling (EPS) was informative in every case showing SF uptake, whereas in cases without SF uptake, the EPS was non-informative, although the tissue was later confirmed as pathological. These findings highlight the interest of SF for perioperative diagnosis of tumor tissue and may suggest in which cases the differentiation of tumor–healthy tissue could be especially blurred, posing difficulties for the pathologist.

Intraoperative Fluorophores: An Update on 5-Aminolevulinic Acid and Sodium Fluorescein in Resection of Tumors of the Central Nervous System and Metastatic Lesions—A Systematic Review and Meta-Analysis

“…Regardless of tumor type, sodium fluorescein demonstrated no significant difference in rate of fluorescence. Out of all studies included in our analysis, all demonstrated fluorescence rates above 77%, and 11 out of 15 demonstrated fluorescence rates > 90% [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. Previous prospective cohort studies by Acerbi have shown a high specificity and sensitivity of fluorescein in glioma detection, citing numbers as high as 79.1% and 80.8%, respectively [12].…”

Fluorescein-guided surgery in high-grade gliomas: focusing on the eloquent and deep-seated areas

“…Indeed, helpful intraoperative fluorescence was identified by surgeons in most tumors of neuroepithelial tissue (HGGs, ependymoma, and glioneuronal tumor), metastases, and primary CNS lymphomas, but not in LGGs, meningiomas, and hemangioblastomas, reported by the FLUOCERTUM study (Falco et al 2019 ). In addition, research on pediatric LGGs-FGS demonstrated that 86% of the lesions showed fluorescence uptake, with 74% of them being helpful for resection (de Laurentis et al 2022 ). In line with the previous results, satisfactory fluorescence of tumor tissues under 560 nm filter was visualized in all 32 cases of HGGs undergoing fluorescence-guided resection included in the present study.…”