(1) Background:
Gangliogliomas comprise a small number of
brain tumors. They usually present as World Health Organization (WHO) grade I, and they delineate on
gadolinium-enhanced MRI; the surgical goal is wide radical resection, and the course thereafter is usually benign.
Fluorescein sodium (FL) tends to accumulate in areas with altered blood-brain barrier (BBB). Thus far, the results provided by prospective and retrospective studies show that the utilization of this fluorophore may be associated with better visualization and improvement of resection for several
tumors of the central nervous system. In this study, we retrospectively studied the effect of
fluorescein sodium on visualization and resection of
gangliogliomas. (2) Methods: Surgical databases in three neurosurgical departments (Regensburg University Hospital; Besta Institute, Milano, Italy; and Liv Hospital, Istanbul, Turkey), with approval by the local ethics committee, were retrospectively reviewed to find
gangliogliomas surgically removed by a
fluorescein-guided technique by the aid of a dedicated filter on the surgical microscope from April 2014 to February 2020. Eighteen patients (13 women, 5 men; mean age 22.9 years, range 3 to 78 years) underwent surgical treatment for
gangliogliomas during 19 operations.
Fluorescein was intravenously injected (5 mg/kg) after
general anesthesia induction.
Tumors were removed using a microsurgical technique with the YELLOW 560 Filter (YE560) (KINEVO/PENTERO 900, Carl Zeiss Meditec, Oberkochen, Germany). (3) Results: No side effects related to
fluorescein occurred. In all
tumors, contrast enhancement on preoperative MRI correlated with bright yellow fluorescence during the
surgical procedure (17
gangliogliomas WHO grade I, 1
ganglioglioma WHO grade II).
Fluorescein was considered helpful by the operating surgeon in distinguishing
tumors from viable tissue in all cases (100%). Biopsy was intended in two operations, and subtotal resection was intended in one operation. In all other operations considered preoperatively eligible, gross total resection (GTR) was achieved in 12 out of 16 (75%) instances. (4) Conclusions: The use of FL and YE560 is a readily available method for safe fluorescence-guided
tumor resection, possibly visualizing
tumor margins intraoperatively similar to contrast enhancement in T1-weighted MRI. Our data suggested a positive effect of
fluorescein-guided surgery on intraoperative visualization and extent of resection during resection of
gangliogliomas.