Application Of Fluorescein-assisted Microsurgical Resection Of Intracranial Malignant Tumors

Objective:To investigate the safety and efficacy of low dose fluorescein sodium staining technique in the resection of intracranial malignant tumors assisted by Pentero 900 fluorescence microscope.Methods:With the approval of the Ethics Committee,we collected patients who came to visit from September 2016 to September 2018 and were suspected to be malignant tumour based on preoperative imaging.Each patient is informed of the benefits and risks associated with the use of FLS and the patient agrees and signs an informed consent.FLS(2.5 mg/kg) was injected intravenously after induction of general anesthesia,with the help of a surgical microscope to judge boundary of tumor to guide microsurgical resection of tumor.Record any allergic reactions or other adverse reactions in the patients.The tumor samples of fluorescent and non-fluorescent areas were collected respectively during the operation.Immunohistochemical Envision method was used to detect the expression of Ki-67,P53 and glial fibrillary acidic protein(GFAP) in the two groups and the results were statistically analyzed.Head magnetic resnane iamge(MRI) was reexamined 72h after surgery,Postoperative tumor volumes after surgery were calculated using an medical image process software or assessed on the image by at least 2 surgeons and 1neuroradiologist.Results:A total of 51 patients were studied,including 31 males and 20 females.The average age of the patients was 45.0 years old,ranging from 7 to 75 years old.Postoperative pathological diagnosis included 9 cases of grade WHO Ⅲ,including 6 cases of anaplastic astrocytoma and 3cases of anaplastic oligodendroglioma.There were 42 cases of grade WHO Ⅳ,including 33cases of glioblastoma,4 cases of metastatic tumor,3 cases of gliosarcoma and 2 cases of medulloblastoma.No adverse reactions or allergic reactions related to FLS administration were found in 51 patients in this study.Yellow staining of sclera,skin and urine disappeared about 24hours after surgery.No abnormal changes were found in the examination of blood,urine routine and liver,renal function.In all cases,the tumor was stained effectively by FLS during the operation,which improved the visualization of tumor boundary.Postoperative tumor EOR:gross total resection(GTR) was achieved in 62.7%(n=32) of patients.Subtotal resection(STR)(95~99%)was achieved in 25.5%(n=13) of them,while partial resection(PR)(5~94%) was obtained in 11.8%(n=6) of patients.The results indicated that the range of tumor resection was improved obviously.The positive expression of the three markers in fluorescent group and non-fluorescent group were Ki-67=36/1(χ~2+51.954,P<0.001),p53=33/2(χ~2+41.800,P<0.001)and GFAP=11/43(χ~2+29.309,P<0.001),respectively(P<0.05).Therefore,the positive rates of Ki-67,P53 and GFAP in tumor tissues with different staining were significantly different,which indicated that there were significant differences in the expression of Ki-67,P53 and GFAP between the fluorescent group and the non-fluorescent group.By comparing the expression of the three markers in the fluorescence group and the non-fluorescence group,the connection between the boundary of intraoperative yellow fluorescence tissue and the pathological boundary of tumor was objectively confirmed.Conclusion:The combination of intraoperative low-dose FLS and Pentero 900 microscopy in the resection of intracranial malignant tumor can improve the ability of the operator to identify tumor boundaries and residual tumors,which has obvious technical advantages.Fluorescein sodium assisted microsurgical resection of intracranial malignant tumors can improve the safety and effectiveness of tumor resection.