Sodium fluorescein guided resection of malignant glioma

The average rate of gross total resection (GTR) for malignant gliomas (MGs) is reported to be around 36%. One of the major challenges to GTR is the recognition of tumour margins. Sodium fluorescein is a freely available fluorophore used to recognize the boundaries of MGs. It accumulates in tumour areas with disrupted blood brain barrier that can then be visualized under a microscope with dedicated filters. No randomized controlled trial or meta-analysis is available that reports the impact of fluorescein use on the extent of tumour resection. Several prospective studies and a phase II trial prove it to be safe and helpful in achieving GTR rates of 68.42-100%. At higher doses i.e., 15-20 mg/Kg, sodium fluorescein can even be used under white illumination. The dye is safe even at high doses and has helped achieve GTR rates of 80-84.4%.