gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Fluorescein Sodium and YELLOW 560nm filter for improved resection of primary high-grade gliomas – the FLUOGLIO trial

Meeting Abstract

  • Francesco Acerbi - Istituto Neurologico Carlo Besta, Milano, Italia
  • Alexander Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Germany
  • Morgan Broggi - Istituto Neurologico Carlo Besta, Milano, Italia
  • Julius Hoehne - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Germany
  • Paolo Ferroli - Istituto Neurologico Carlo Besta, Milano, Italia
  • Karl-Michael Schebesch - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.15.03

doi: 10.3205/16dgnc182, urn:nbn:de:0183-16dgnc1820

Published: June 8, 2016

© 2016 Acerbi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Fluorescein is used as a fluorescent tracer for several applications. Its capability to accumulate in cerebral areas where the blood-brain barrier has been damaged can be exploited for the intraoperative visualization of high-grade gliomas (HGG). The results of a prospective multicentric (Besta Institute in Milan and University Hospital in Regensburg) phase II trial on fluorescein-guided technique resection of HGG (FLUOGLIO) are presented.

Method: In September 2011 the FLUOGLIO study was started to evaluate safety and efficacy of fluorescein-guided surgery for HGG. 46 patients (mean age 63, range 40-74) have been enrolled. Fluorescein was injected after intubation or immediately at the entrance in the OR for awake patients (5-10 mg/kg). Intraoperative visualization was performed with a dedicated filter on the surgical microscope (BLU400 or YELLOW560, Pentero Zeiss). In 13 patients, up to 4 biopsies were performed at the tumor margin in fluorescent and non-fluorescent areas to evaluate sensitivity and specificity of fluorescein in tumor tissue identification. Patients were submitted to post-operative Stupp protocol and followed-up to evaluate progression free survival (PFS) and overall survival (OS).

Results: Mean pre-operative tumor volume was 28.74 cm3. Complete resection was achieved in 83% of patients on early postoperative MRI. No adverse reactions related to fluorescein administration were registered. An immediate slight deterioration in NIHSS (1.2 ± 0.2 vs 2.9 ± 0.6) and KPS (87.4 ± 1.7 vs 78.2 ± 2.6) was registered. With a mean follow-up of 13 months, the 6 months PFS rate was 73.3% Sensitivity and specificity of fluorescein in identifying tumor tissue was 80.8% and 79.1% respectively.

Conclusions: The results of FLUOGLIO study suggest that fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows a high-rate of complete resection of HGG as confirmed at the early post-operative MRI.