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

Area of Science:

• Pediatric Neurosurgery
• Oncology
• Medical Imaging

Background:

• Low-grade gliomas are common pediatric CNS lesions.
• Surgery is a primary treatment, with intraoperative tools enhancing outcomes.
• Sodium fluorescein (SF) is used in adult high-grade lesions, but its role in pediatric low-grade gliomas is not well-defined.

Purpose of the Study:

• To evaluate the utility of sodium fluorescein (SF) in pediatric low-grade glioma surgery.
• To assess SF uptake, intraoperative helpfulness, and correlation with preoperative imaging and pathology.

Main Methods:

• Retrospective review of 22 pediatric CNS low-grade gliomas operated on with SF (September 2021 - October 2022).
• Analysis of SF uptake, intraoperative utility, correlation with MRI gadolinium enhancement, and extemporaneous pathological sampling (EPS) results.

Main Results:

• 86% of lesions demonstrated SF uptake.
• SF was helpful intraoperatively in 74% of cases for localization and remnant identification.
• SF uptake correlated with preoperative gadolinium enhancement on MRI.
• EPS was informative in all cases with SF uptake, but not in cases without uptake.

Conclusions:

• Sodium fluorescein (SF) shows promise for perioperative diagnosis in pediatric low-grade gliomas.
• SF may help delineate tumor margins in cases where tumor-healthy tissue differentiation is challenging for pathologists.