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Abstract：
OBJECTIVE: The vital function of eloquent and deep brain areas necessitates precise treatment for tumors located in these regions. Fluorescein-guided surgery (FGS) has been widely used for high-grade gliomas (HGGs) resection. Nevertheless, the safety and efficacy of utilizing this technique for resecting brain tumors located in eloquent and deep-seated areas remain uncertain. This study aims to assess the safety and extent of resection of HGGs in these challenging tumors with fluorescein and explore its impact on patient survival.
METHODS: A retrospective analysis was conducted on the clinical and radiological data of 67 consecutive patients with eloquent or deep-seated HGGs who underwent surgery between January 2020 and June 2023. Lacroix functional location grade was used to determine the eloquence of the tumors. The comparison between the fluorescence-guided surgery group (FGS, n = 32) and the conventional white-light microscopic surgery group (non-FGS, n = 35) included assessments of extent of resection (EOR), rates of gross total resection (GTR, 100%) and near-total resection (NTR, 99 to 98%), postoperative Neurologic Assessment in Neuro-Oncology (NANO) scores, overall survival (OS), and progression-free survival (PFS), to evaluate the safety and efficacy of fluorescein-guided technology in tumor resection at these specific locations.
RESULTS: Baseline of demographics, lesion location, and pathology showed no significant difference between the two groups. GTR of the FGS group was higher than the non-FGS group (84.4% vs. 60.0%, OR 3.60, 95% CI 1.18-10.28, p < 0.05). The FGS group also showed higher GTR + NTR (EOR ≥ 98%) than the non-FGS group (93.8% vs. 65.7%, OR 7.83, 95% CI 1.86-36.85, p < 0.01). 87.0% of eloquent tumors (Lacroix grade III) in the FGS group achieved GTR + NTR, compared to 52.2% of control group (OR 6.11, 95% CI 1.50-22.78, p < 0.05). For deep-seated tumors, the rate of GTR + NTR in the two groups were 91.7% and 53.3%, respectively (OR 9.62, 95% CI 1.05-116.50, p < 0.05). No significant difference of the preoperative NANO score of the two groups was found. The postoperative NANO score of the FGS group was significantly lower than the non-FGS group (2.56 ± 1.29 vs. 3.43 ± 1.63, p < 0.05). Median OS of the FGS group was 4.2 months longer than the non-FGS group despite no statistical difference (18.2 months vs. 14.0 months, HR 0.63, 95% CI 0.36-1.11, p = 0.112), while PSF was found significantly longer in FGS patients than those of the non-FGS group (11.2 months vs. 7.7 months, HR 0.59, 95% CI 0.35-0.99, p < 0.05).
CONCLUSIONS: Sodium fluorescein-guided surgery for high-grade gliomas in eloquent and deep-seated brain regions enables more extensive resection while preserving neurologic function and improve patient survival.
METHODS: A retrospective analysis was conducted on the clinical and radiological data of 67 consecutive patients with eloquent or deep-seated HGGs who underwent surgery between January 2020 and June 2023. Lacroix functional location grade was used to determine the eloquence of the tumors. The comparison between the fluorescence-guided surgery group (FGS, n = 32) and the conventional white-light microscopic surgery group (non-FGS, n = 35) included assessments of extent of resection (EOR), rates of gross total resection (GTR, 100%) and near-total resection (NTR, 99 to 98%), postoperative Neurologic Assessment in Neuro-Oncology (NANO) scores, overall survival (OS), and progression-free survival (PFS), to evaluate the safety and efficacy of fluorescein-guided technology in tumor resection at these specific locations.
RESULTS: Baseline of demographics, lesion location, and pathology showed no significant difference between the two groups. GTR of the FGS group was higher than the non-FGS group (84.4% vs. 60.0%, OR 3.60, 95% CI 1.18-10.28, p < 0.05). The FGS group also showed higher GTR + NTR (EOR ≥ 98%) than the non-FGS group (93.8% vs. 65.7%, OR 7.83, 95% CI 1.86-36.85, p < 0.01). 87.0% of eloquent tumors (Lacroix grade III) in the FGS group achieved GTR + NTR, compared to 52.2% of control group (OR 6.11, 95% CI 1.50-22.78, p < 0.05). For deep-seated tumors, the rate of GTR + NTR in the two groups were 91.7% and 53.3%, respectively (OR 9.62, 95% CI 1.05-116.50, p < 0.05). No significant difference of the preoperative NANO score of the two groups was found. The postoperative NANO score of the FGS group was significantly lower than the non-FGS group (2.56 ± 1.29 vs. 3.43 ± 1.63, p < 0.05). Median OS of the FGS group was 4.2 months longer than the non-FGS group despite no statistical difference (18.2 months vs. 14.0 months, HR 0.63, 95% CI 0.36-1.11, p = 0.112), while PSF was found significantly longer in FGS patients than those of the non-FGS group (11.2 months vs. 7.7 months, HR 0.59, 95% CI 0.35-0.99, p < 0.05).
CONCLUSIONS: Sodium fluorescein-guided surgery for high-grade gliomas in eloquent and deep-seated brain regions enables more extensive resection while preserving neurologic function and improve patient survival.
摘要：
目的：雄辩和深部脑区的重要功能需要对位于这些区域的肿瘤进行精确治疗。荧光素引导手术（FGS）已广泛用于高级别神经胶质瘤（HGG）切除。然而，利用该技术切除位于雄辩和深层区域的脑肿瘤的安全性和有效性仍不确定.这项研究旨在评估在这些具有挑战性的肿瘤中使用荧光素切除HGs的安全性和程度，并探讨其对患者生存的影响。
方法：对在2020年1月至2023年6月期间接受手术的67例雄辩性或深层HGG患者的临床和放射学数据进行了回顾性分析。Lacroix功能定位等级用于确定肿瘤的雄辩性。荧光引导手术组(FGS，n=32）和常规白光显微镜手术组（非FGS，n=35)包括对切除程度(EOR)的评估，总切除率(GTR，100%)和近乎完全切除(NTR，99至98％），神经肿瘤学术后神经系统评估（NANO）评分，总生存期（OS），和无进展生存期（PFS），评估荧光素引导技术在这些特定位置的肿瘤切除中的安全性和有效性。
结果：人口统计基线，病变位置,两组间病理差异无统计学意义。FGS组的GTR高于非FGS组（84.4%vs.60.0%,OR3.60，95%CI1.18-10.28，p<0.05）。FGS组的GTR+NTR（EOR≥98%）也高于非FGS组（93.8%vs.65.7%,OR7.83，95%CI1.86-36.85，p<0.01）。FGS组中87.0%的雄辩性肿瘤(LacroixIII级)达到GTR+NTR,对照组52.2%(OR6.11,95%CI1.50-22.78,p<0.05)。对于深层肿瘤，两组GTR+NTR的发生率分别为91.7%和53.3%,分别为(OR9.62，95%CI1.05-116.50，p<0.05)。两组患者术前NANO评分差异无统计学意义。FGS组术后NANO评分明显低于非FGS组(2.56±1.29vs.3.43±1.63，p<0.05）。FGS组的中位OS比非FGS组长4.2个月，尽管没有统计学差异（18.2个月与14.0个月，HR0.63，95%CI0.36-1.11，p=0.112），而FGS患者的PSF明显长于非FGS组（11.2个月vs.7.7个月，HR0.59，95%CI0.35-0.99，p<0.05)。
结论：荧光素钠引导手术治疗脑区和深部高级别胶质瘤可以实现更广泛的切除，同时保留神经功能并提高患者生存率。
方法：对在2020年1月至2023年6月期间接受手术的67例雄辩性或深层HGG患者的临床和放射学数据进行了回顾性分析。Lacroix功能定位等级用于确定肿瘤的雄辩性。荧光引导手术组(FGS，n=32）和常规白光显微镜手术组（非FGS，n=35)包括对切除程度(EOR)的评估，总切除率(GTR，100%)和近乎完全切除(NTR，99至98％），神经肿瘤学术后神经系统评估（NANO）评分，总生存期（OS），和无进展生存期（PFS），评估荧光素引导技术在这些特定位置的肿瘤切除中的安全性和有效性。
结果：人口统计基线，病变位置,两组间病理差异无统计学意义。FGS组的GTR高于非FGS组（84.4%vs.60.0%,OR3.60，95%CI1.18-10.28，p<0.05）。FGS组的GTR+NTR（EOR≥98%）也高于非FGS组（93.8%vs.65.7%,OR7.83，95%CI1.86-36.85，p<0.01）。FGS组中87.0%的雄辩性肿瘤(LacroixIII级)达到GTR+NTR,对照组52.2%(OR6.11,95%CI1.50-22.78,p<0.05)。对于深层肿瘤，两组GTR+NTR的发生率分别为91.7%和53.3%,分别为(OR9.62，95%CI1.05-116.50，p<0.05)。两组患者术前NANO评分差异无统计学意义。FGS组术后NANO评分明显低于非FGS组(2.56±1.29vs.3.43±1.63，p<0.05）。FGS组的中位OS比非FGS组长4.2个月，尽管没有统计学差异（18.2个月与14.0个月，HR0.63，95%CI0.36-1.11，p=0.112），而FGS患者的PSF明显长于非FGS组（11.2个月vs.7.7个月，HR0.59，95%CI0.35-0.99，p<0.05)。
结论：荧光素钠引导手术治疗脑区和深部高级别胶质瘤可以实现更广泛的切除，同时保留神经功能并提高患者生存率。
