Blood-Brain Barrier Disruption, Sodium Fluorescein, And Fluorescence-Guided Surgery Of Gliomas

Abstract

Purpose: Sodium fluorescein (SF) is an ideal dye for intraoperative guided-resection of high-grade gliomas (HGGs). However, it is not well understood whether the SF-guided technique is suitable for different grades of gliomas, and the correlation between fluorescence and pathology is also not yet clear.

Materials and methods: In this study, we investigated 28 patients, including 23 patients with HGG and 5 patients with low-grade glioma (LGG). All patients were treated using the SF-guided technique on a Pentero 900 microscope (Carl Zeiss, Oberkochen, Germany). Claudin-5 immunohistochemical (IHC) staining for the tumours and peritumour tissues was analyzed.

Results: Intraoperative yellow fluorescence was noted in all the HGGs but not in the LGGs. Claudin-5 expression in the blood brain barrier endothelial cells was downregulated and disconnected in the HGGs (p < 0.05), but had no difference or slightly decreased in the LGGs (p > 0.05).

Conclusions: The SF-guided technique is suitable for HGG surgery but not for LGG surgery. Downregulation of claudin-5 expression may contribute to the presence of yellow fluorescence in the glioma in SF-guided surgery.

Keywords:

• Sodium fluorescence-guided technique
• glioma surgery
• blood brain barrier
• pathology
• claudin-5

Acknowledgements

We thank Professor Ya-Wen Pan (Department of Neurosurgery, The Second Hospital of Lanzhou University, Lanzhou, China) for useful comments on the manuscript, and Professor Xiao-Hong Yao (Department of Pathology, Southwest Hospital, Third Military Medical University, Chongqing, China) for analyzing molecular pathological data. This work was partly supported by the National Natural Science Foundation of China (NSFC 81272783).

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

National Natural Science Foundation of China, 10.13039/501100001809, NSFC 81272783.