Purpose: Sodium fluorescein is a dye that, intravenously injected, selectively accumulates in high-grade glioma (HGG) tissue through a damaged blood-brain barrier. In this article, the final results of a multicentric prospective phase II trial (FLUO-GLIO) on fluorescein-guided HGG resection through a dedicated filter on the surgical microscope were reported.Methods: Patients with suspected HGGs considered suitable for removal were eligible to participate in this trial. Fluorescein was intravenously injected at a dose of 5 to 10 mg/kg. The primary endpoint was the percentage of patients with histologically confirmed HGGs, without contrast-enhancing tumor at the immediate postoperative MRI. Secondary endpoints were PFS, residual tumor on postoperative MRI, overall survival, neurologic deficits, and fluorescein-related toxicity. The sensitivity and specificity of fluorescein in identifying tumor tissue were estimated by fluorescent and nonfluorescent biopsies at the tumor margin. The study was registered on the European Regulatory Authorities website (EudraCT 2011-002527-18).Results: Fifty-seven patients aged 45 to 75 years were screened for participation, and 46 were considered for primary and secondary endpoints. Mean preoperative tumor volume was 28.75 cm 3 (range, 1.3-87.8 cm 3 ). Thirty-eight patients (82.6%) underwent a complete tumor removal. Median follow-up was 11 months. PFS-6 and PFS-12 were 56.6% and 15.2%. Median survival was 12 months. No adverse reaction related to SF administration was recorded. The sensitivity and specificity of fluorescein in identifying tumor tissue were respectively 80.8% and 79.1%.Conclusions: Fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and enables a high percentage of contrast-enhancing tumor in patients with HGGs.

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According to our results, it seems to be the possible that temporary vessel occlusion is an additional factor in aggravating vasospasm after aneurysmatic subarachnoid hemorrhage.

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Microsurgical resection is the primary treatment of skull base meningiomas. Maximal resection provides the best tumor control rates but can be associated with high surgical morbidity. To understand the relation between extent of resection (EOR) and functional outcome we have analyzed the neurological improvement and recurrence rate in a large consecutive series of skull base meningioma patients. In addition, we defined anatomical and biological factors predictive for recurrence and overall outcome. We investigated 226 skull base meningioma patients receiving tumor resection in our institution. The most frequent location was the medial sphenoid ridge (29.6 %). EOR was rated according to the Simpson scale. Overall performance was measured by the Karnofsky performance score (KPS); neurological deficits were quantified using the Medical Research Council Neurological Severity Score (MRC-NPS). Complete resection was achieved in 62.8 % and the EOR was significantly correlated to tumor location. The morbidity and mortality rate was 32.1 and 2.7 % respectively, new permanent neurological deficits occurred in 3.5 % of all patients. From all patients with focal neurological deficits, 60.1 % experienced significant improvement. Both the MRC-NPS and the KPS significantly improved from the preoperative status to discharge, however the improvement rate was dependent on the tumor location. Recurrence rate was 15.5 %; tumor size, bone- and venous sinus infiltration, WHO grade, poor EOR but not MIB-1 labeling index were independent factors predictive for recurrence. Microsurgical resection of skull base meningiomas improves neurological impairment in the majority of patients. Specific risk factors for recurrence require consideration for postoperative management.

Highly accurate fusion of MR images and real-time ultrasonography could be achieved. However, careful interpretation of the fused data is necessary, when different angles and distances of the US probe to the object are concerned.

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