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  • Utility of Sodium Fluorescein for Achieving Resection Targets in Glioblastoma Multiforme: The WVU Experience

    Final Number:

    Sanjay Bhatia MBBS, MS, MCh; Darnell T Josiah MS, MD; Roy S Hwang; Gennadiy Katsevman MD; Ryan C. Turner MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: It is commonly reported that achieving a gross total resection of contrast enhancing areas in patients with glioblastoma multiforme improves overall survival following surgery in comparison to sub-total resection. Efforts to achieve improved resection targets have included the use of both imaging and pharmacological adjuvants.

    Methods: Standard contrast-enhanced MRI sequences and neuronavigation were utilized for pre-operative planning. Intra-operatively sodium fluorescein was administered and visualized both in white light and under a fluorescent filter.

    Results: We utilized sodium fluorescein in a total of 25 patients with glioblastoma multiforme and were able to demonstrate a significant improvement in our resection rates for a total of 84% complete or near total resections (>98%). Perhaps most importantly, in 19 cases thought not to be amenable to complete resection, 6 (32%) of these cases achieved total resection following the use of sodium fluorescein. Overall, the primary surgeon felt that sodium fluorescein use facilitated resection and was considered helpful in 96% of cases in which it was utilized, including dominant-side resections, particularly within speech and motor regions.

    Conclusions: This work demonstrates the promise of an affordable and easy-to-implement strategy for improving rates of total resection of contrast enhancing areas in patients with glioblastoma multiforme. This may potentially improve progression free and overall survival in this cohort.

    Patient Care: This work demonstrates a practical, cost-effective, and timely approach for improving the extent of contrast-enhancing tumor volume resected in patients with glioblastoma multiforme. Improving the rate of gross total resection will lead to improved symptom-free and total survival.

    Learning Objectives: 1.) Explore modalities utilized in achieving desired resection targets in the management of glioblastoma multiforme 2.) Investigate the role of sodium fluorescein in improving the rate of gross total resection of glioblastoma multiforme 3.) Discuss future directions of sodium fluorescein in tumor resection

    References: 1.) Stummer W, et al. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006; 7:392-401. 2.) Sanai N, et al. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 2011; 115: 3-8. 3.) Stummer W, et al. Extent of Resection and Survival in Glioblastoma Multiforme: Identification of and Adjustment for Bias. Neurosurgery 2008; 62:564-576.

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