Resection Of Glioma With Fluorescence-sodium Guided: A Clinical Study

Gliomas are the most common primary malignant brain tumor, the patientswith poor prognosis,also presening a high level. Data statistics illustrate1-yearand2-year survival rate is only53.7%and14.6%to patients with high-gradegliomas. And showing there are more and more patients with high-grade gliomain recent years. And because of its refractory characteristics, morbidity,recurrence rate, high mortality and low cure rate characteristics, most patientshave very poor prognosis. The treatment of malignant gliomas in Neurosurgerystill facing problems. Now comprehensive treatment was used in gliomatherapy program, for example: surgery、radiotherapy and chemotherapy etc.Clinical studies have shown that surgical resection is still considered to be thefirst program of glioma treatment, and is considered the pivotal prognosticfactor to the patient. But because the permeability of glioma is difficult todistinguish the boundary of tumor and normal brain parenchyma, which makesthe complete resection of the tumor more difficult to achieve. If the boundaryof tumor tissue can be determined in a more intuitive operation,we can getsurgical resection of the tumor as possible as we can. Sodium fluorescein wasapplicated in glioma resection can significantly improve the whole cut rates,improve prognosis.Objective:The purpose of this study was to evaluate the clinical application of theuse of sodium fluorescein in surgical resection.Methods:There are60patients diagnosed with glioma which was enrolled in2011July to2013July were radom divided in two study. There are30cases of gliomapatients was resected by sodium fluorescein in the intraoperative, andaccording to the intensity of sodium fluorescein staining of tumor tissue (darkyellow, light yellow, no staining) to determine the tumor boundary and as abasis to remove the tumor.30cases of glioma is operated according to theexperience of surgeon’s microsurgery experiences. Count data, measurementdata were used X2test, t test for statistical analysis, full cut rates, KPS score,operative time and hospital stay was compared through two groups of patientsResults:1. Fluorescein sodium guided operation groups:tumor resection andpathological examination is consistent,postoperative radiographic examinationshowed tumor resection is complete compared with the traditional resection.2. There are26cases of patient were totally cut in the experimental group(86.7%), control group operation group total resection was achieved in17cases(56.7%), the difference was statistically significant (P<0.05); in the nonfunctional area, there were statistically significant differences in total removalrate of two groups (P<0.05).3. In functional areas, guide the operation of group differences in KPSscores before and after operation of fluorescein sodium was statisticallysignificant (P<0.05); there was no significant difference of KPS score oftraditional operation group before and after operation (P>0.05).Conclusion:1. Application of Fluorescein sodium-guided help to increase the the totalresection rate of glioma.2. For patients with glioma located in functional areas, we combine neurophysiological monitoring, can significantly improve postoperative KPSscore.3. After surgical resection, combined chemotherapy,which is usingTemozolomide and radiation therapy can significantly prolong progression-freesurvival.4. We do not recommend the use of fluorescein sodium in low-gradegliomas cases.