Isocitrate Dehydrogenase Wild-type Glioblastoma Resection Under Fluorescein Sodium and White Light Guidance Based on Response Assessment in Neuro-Oncology Resect Criteria: Fluorescein Significantly Enhances Complete Resection Rate of Enhanced Tumors

BACKGROUND AND OBJECTIVES: Increasing the extent of resection (EOR) of the contrast-enhanced (CE) portion of glioblastoma can lead to survival benefits. There has never been a unified assessment of the specific EOR that sodium fluorescein–guided surgery can achieve. Based on the latest resection classification from the Response Assessment in Neuro-Oncology (RANO) resection group, we conducted a grouped analysis of the tumor resection extent by comparing with surgeries performed under white light (WL). METHODS: A total of 162 patients were included in this comparative study, divided into the fluorescence group and the WL group. The primary outcome of the study was the extent of tumor resection, using Brainlab software to outline the tumors and calculate volumes. The tumors were then categorized according to the RANO criteria for EOR, and the results were analyzed in conjunction with factors influencing the extent of surgical resection. RESULTS: The residual CE tumor volume in the fluorescence group was significantly lower than that in the WL group ( P = .023). According to the RANO classification criteria, there was a significant difference in the distribution of residual tumor volume categories between the 2 groups ( P = .015). In the fluorescence group, the proportion of patients with a residual CE tumor volume of “0” cm 3 (RANO I + IIA) was 62.2%, higher than the 42.5% in the WL group, with a significant difference ( P = .012). Molecular biomarker association analysis indicates that the proportion of O6-methylguanine-DNA methyltransferase–methylated patients achieving tumor resection to the IIA group is significantly higher than that of unmethylated patients ( P = .005). CONCLUSION: The CE tumor total resection rate guided by sodium fluorescein is superior to that of traditional WL surgery, offering the possibility of achieving a more thorough CE resection. Moreover, patients with methyltransferase gene methylation are more likely to achieve complete resection (CE) of the tumor without residual.