[The sodium fluorescein-guided microsurgical resection of glioblastoma]

Objective: To investigate the clinic effect of the sodium fluorescein-guided microsurgical resection of glioblastoma. Methods: In a retrospective clinical study, 82 patients with glioblastoma confirmed by post-operative pathologic inspection in the Department of Neurosurgery of Tianjin Huanhu Hospital from January 2016 to June 2017 were randomly divided into sodium fluorescein (FL) group (42 cases) and traditional microsurgical (TM) group (40 cases). The tumors were removed by the sodium fluorescein-guided surgical procedure in the FL group. The tissues which displayed different intensity of fluorescent staining were taken for the pathologic inspection. The resection of tumors were completed under common microscope in the TM group. The two groups of patients underwent MRI enhanced scan at 48 hours after operation to determine the degree of tumor resection. The rate of gross total resection, postoperative complication, recurrent rate of two groups were compared by χ(2) test or Fisher exact test. Results: Totally 135 fluorescent staining samples were obtained in the FL group. Forty-two samples were showed strong fluorescent staining, and all samples were proved to be tumor tissue by pathologic inspection, the sensitivity of FL was 100%. Thirty-seven gliomas were detected from 45 samples of faintly fluorescent staining, sensitivity of FL was 82.3%. Eight gliomas were found from 48 samples of non-fluorescent staining, the specificity of FL was 83.3%. The total resection rate of sodium fluorescein group was 85.7% (36/42), higher than that of traditional microsurgical group (62.5% (25/40)) (χ(2)=5.795, P=0.016). Two groups of patients were followed up to 6 months after the operation, and 6 cases (14.3%, 6/42) were recurred in the FL group. Among them, 1 case died and the average Karnofsky performance score was 82.2±15.2. There were 12 recurrent cases (33.3%, 12/36) in the TM group, of which 2 cases were died and the average Karnofsky performance score was 76.9±20.3. There was significantly statistical difference in recurrent rate (χ(2)=3.962, P=0.047). Conclusions: The sensitivity and specificity of fluorescein staining in glioblastoma tissue are high. And the application of sodium fluorescein-guided microsurgical resection of glioblastoma is safe and simple. Therefore, it is helpful to improve the total resection rate of glioblastoma patients and reduce the recurrence rate.