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

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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.

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Authors and Affiliations

  1. Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil

    Marcos Devanir Silva da Costa, Herison Harrider Silva Vaz, Patricia Alessandra Dastoli, Jardel Mendonça Nicácio, Adib Saraty Malveira, Esdras Ismael Borrayo Flores & Sergio Cavalheiro

  2. Division of Neurosurgery, Instituto de Oncologia Pediatrica (IOP/GRAACC), Sao Paulo, SP, Brazil

    Marcos Devanir Silva da Costa, Patricia Alessandra Dastoli, Jardel Mendonça Nicácio & Sergio Cavalheiro

  3. Department of Neurosurgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA

    Nicole A. Silva

Authors
  1. Marcos Devanir Silva da Costa
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  2. Herison Harrider Silva Vaz
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  3. Nicole A. Silva
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  4. Patricia Alessandra Dastoli
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  5. Jardel Mendonça Nicácio
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  7. Esdras Ismael Borrayo Flores
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  8. Sergio Cavalheiro
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Contributions

Marcos Devanir Silva da Costa, conceptualization, data acquisition, editing, and reviewing. Herison Harrider Silva Vaz, writing original draft, data acquisition, editing, and reviewing. Nicole A. Silva, reviewing and editing. Patricia Alessandra Dastoli, supervision, reviewing, and editing. Jardel Mendonça Nicácio, supervision, reviewing, and editing. Adib Saraty Malveira, reviewing and editing. Adib Saraty Malveira, data acquisition, reviewing, and editing. Esdras Ismael Borrayo Flores, data acquisition, reviewing, and editing. Sergio Cavalheiro, supervision, reviewing, and editing.

Corresponding author

Correspondence to Herison Harrider Silva Vaz.

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The study was approved by the Research Ethics Committee of the Universidade Federal de São Paulo, São Paulo, Brazil. Informed consent was obtained from the guardians.

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Informed consent was obtained from the guardians for publication.

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The authors declare no competing interests.

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da Costa, M.D.S., Vaz, H.H.S., Silva, N.A. et al. Fluorescein-guided resection for pediatric low-grade gliomas: institutional experience on two cases and a narrative literature review. Childs Nerv Syst 39, 1485–1493 (2023). https://doi.org/10.1007/s00381-022-05773-4

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