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Review
. 2023 Jun;39(6):1485-1493.
doi: 10.1007/s00381-022-05773-4. Epub 2022 Dec 1.

Fluorescein-guided resection for pediatric low-grade gliomas: institutional experience on two cases and a narrative literature review

Marcos Devanir Silva da Costa  1   2 , Herison Harrider Silva Vaz  3 , Nicole A Silva  4 , Patricia Alessandra Dastoli  1   2 , Jardel Mendonça Nicácio  1   2 , Adib Saraty Malveira  1 , Esdras Ismael Borrayo Flores  1 , Sergio Cavalheiro  1   2
Affiliations
Review

Fluorescein-guided resection for pediatric low-grade gliomas: institutional experience on two cases and a narrative literature review

Marcos Devanir Silva da Costa et al. Childs Nerv Syst. 2023 Jun.

Abstract

Purpose: Low-grade gliomas compose 30% of pediatric central nervous system tumors and outcomes of disease-free progression, and survival is directly correlated to the extent of resection. The use of sodium fluorescein (Na-Fl) is an intraoperative method in the localization of tumor cells in adult patients to optimize resection. Our purpose is to describe the use of Na-Fl in pediatric low-grade gliomas and its outcomes.

Methods: Patients under 18 years of age with low-grade gliomas at the author's institution underwent resection with the use of Na-Fl, with review of preoperative imaging findings, intraoperative results, and follow-up. Then, a comprehensive, narrative literature review of the use of Na-Fl in pediatric low-grade glioma was performed.

Results: Our single-institution use of Na-Fl in pediatric patients with suspected low-grade glioma demonstrated excellent results of intraoperative enhancement of tumor cells as well as gross total resection. The literature demonstrated 84% Na-Fl staining and 59.2% of gross total resection in pediatric low-grade gliomas with few small case studies, a range of reported findings, and few side effects.

Conclusion: Na-Fl has a promising use in low-grade glioma resection in the pediatric patient population. Further research is warranted, such as randomized controlled studies, to assess Na-Fl as a potential tool in improving resection and long-term favorable outcomes.

Keywords: Fluorescein-guided surgery; Low-grade gliomas; Pediatric neuro-oncology.

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