Combined fluorescein sodium and intraoperative ultrasound enhance resection and functional outcomes in high-grade glioma surgery.

[OBJECTIVE] This study aimed to evaluate the clinical efficacy of combining fluorescein sodium with intraoperative ultrasound (ioUS) for microsurgical resection of high-grade gliomas (HGGs).

[METHODS] In this multicenter retrospective cohort study, 228 patients with HGG were grouped based on the surgical approach: 122 underwent fluorescein sodium + ioUS-guided resection, whereas single-centre 106 received conventional microsurgery (control). Outcomes included gross total resection (GTR) rates, tumour recurrence at 3-6 months, postoperative Karnofsky Performance Status (KPS) scores, intraoperative haemorrhage value and operation time, length of hospital stay and complications.

[RESULTS] The fluorescein sodium + ioUS group achieved significantly higher GTR rates (91.0 %¦vs 74.5 %; P < 0.001) and lower recurrence rates at both 3 months (4.1 %¦vs 12.3 %; P = 0.027) and 6 months (9.0 %¦vs 23.6 %; P = 0.002) than the control group. Functional recovery (the KPS) improved more substantially in the fluorescein sodium + ioUS group at 1 month (85.9 vs 77.6; P < 0.001) and 6 months (90.9 vs 82.5; P < 0.001) postoperatively. Intraoperative haemorrhage (255.9 vs 338.5 mL), operation time (2.6 vs 3.4 h) and hospital stay (14.8 vs 20.4 days) were significantly reduced (P < 0.001 for all) in the fluorescein sodium + ioUS group compared with the control group. Complication rates did not differ significantly between the groups (P = 0.104).

[CONCLUSION] This retrospective study suggests that the combination of fluorescein sodium and ioUS may improve GTR, reduce early recurrence, enhance functional recovery and optimise surgical efficiency in HGG resection. Prospective studies are warranted to confirm these results.