Introduction: High grade glioma is a very disappointing tumour with high rate of short term recurrence although it is followed by chemotherapy and/or radiotherapy. Also, it is difficult to resect it totally especially in eloquent area. The extent of resection is the corner stone predictor of progression-free survival. Gross total tumour resection offers a better prognosis and a longer life expectancy.
Methods: A retrospective study done on 23 patients suffering from high grade glioma operated upon. The age ranged between 39 and 67 years old with mean age of 52.4 years. Approximately 250 mg of sodium fluorescein (3–4 mg/kg bodyweight) was administered intravenously during induction of anaesthesia. After dural opening the surgical microscope (PENTERO 900, Carl Zeiss Meditec, Germany) equipped with a YELLOW 560 nm filter (YELLOW 560 nm, Carl Zeiss Meditec, Oberkochen, Germany) for visualisation of the stained tumor tissue and better identification of the tumor brain interface. 5ml sodium fluorescein ampoule costs 0.3 $, and available in the market.
Results: Gross total resection of the contrast-enhancing tumor was achieved in 20 patients (87%). Glioblastoma multiform was pathologically proved in 16 patients. The temporal lobe was the common site to be affected (16 cases), whereas corpus callosum was affected in only 5 cases. New post-operative deficits was found in 4 patients. In comparison to the literature, it lowers the incidence of repeated surgery which saves more expenses. There wasn’t any allergic reaction or side effect from sodium fluorescein usage.
Conclusions: Sodium fluorescein is a safe and cost-effective technique in resection of High-Grade Glioma. This technique helps in identification and visualisation of the pathologic tissue and helps in achieving a better tumor gross total resection with minimal neurological deficits, but it has no role in identification of eloquent areas.
Patient Care: Our research shows the financial and surgical benefit of using sodium fluorescein guided resection of High-Grade Glioma. It helps in identification of the tumor brain interface, which results in gross total resection. This in return, improves over all survival.
Learning Objectives: To show how sodium fluorescein usage in achieving a gross total resection of high grade glioma, is safe and cost effective.