Fluorescein-guided resection versus non-fluorescein-guided resection of high-grade gliomas: A prospective randomized controlled study

Objectives: The objective is to quantify the extent of resection (EOR) and assess the survival of High-grade gliomas (HGG) using intraoperative fluorescein sodium compared to non-fluoresceinguided resection using pre-operative and post-operative contrast-enhanced magnetic resonance imaging. Materials and Methods: A prospective randomized controlled study was carried out in which the study group underwent florescence guided surgery (FGS) and was compared with non-FGS control group. Evaluation was done on EOR and gross total resection (GTR) based on radiological imaging. Karnofsky performance status (KPS), length of hospital stay, and survival rate were also evaluated. Results: Thirty-two patients (16 in each group) with Grade 3/4 gliomas with comparable pre-operative clinical features and tumor volume were recruited. In the study group, the mean EOR was found to be 95.13% and the control group showed an EOR of 85.19%, which was statistically significant ( P = 0.046). There was also a statistically significant difference in GTR rates ( P = 0.046) and KPS at 3 months (0.050) between the two groups. Conclusion: Microscopic fluorescein-guided resection of HGGs is feasible and safe. The present study was able to demonstrate higher rates of EOR and GTR in the FGS group, which resulted in a higher KPS score as compared to the non-FGS group.