Safety and feasibility of low-dose fluorescein-guided resection of glioblastoma

Using Fluorescein in the Resection of a Pediatric Posterior Fossa Tumor

“…Extent of resection of brain tumors is an important factor affecting progression-free survival. [1][2][3][4][5] Due to the infiltrative nature of tumors 4 and the related intraoperative challenges of identifying tumoral tissue at the resection margin, 6,7 achieving gross total resection may be difficult. Numerous adjuncts are currently employed to facilitate resection; one technique is fluorescentguidance, in which tumor cells are made to fluoresce during resection.…”

“…Numerous adjuncts are currently employed to facilitate resection; one technique is fluorescentguidance, in which tumor cells are made to fluoresce during resection. [1][2][3][4][5][6]8 Fluorescein sodium is an organic fluorescent dye that emits fluorescent radiation at wavelengths of 540-690 nm. Fluorescein accumulates in regions where the blood-brain barrier is disrupted, as in tumoral tissue.…”

“…During her recovery, the patient developed bright yellow-green coloration in her urine, as has been previously described in the literature. 1,6 This resolved within 48 hours following administration of IV fluids. Pathology confirmed the lesion to be consistent with WHO grade IV medulloblastoma, with large cell/anaplastic histology.…”

“…Gross total resection of brain lesions has been linked with improved progression-free survival [1][2][3][4][5] ; however, this may pose an intraoperative challenge in cases where the borders of a lesion are poorly delineated. Although often beneficial, typical surgical adjuncts have their limitations.…”

“…4 5-Aminolevulinic acid (5-ALA) is another fluorophore that has been studied in high-grade glioma surgery. 7 However, 5-ALA is associated with skin sensitization to sunlight and porphyria 1 and requires administration hours prior to the induction of anesthesia. 6 In contrast, fluorescein is largely nontoxic, can be administered at the time of induction, is less costly, and is widely available, making it a suitable alternative for fluorescent-guided surgery.…”