Sodium fluorescein in pediatric brain tumor surgery: a retrospective volumetric analysis of resection extent and consistency

Purpose Maximizing the extent of resection (EOR) while preserving neurological function remains a key challenge in pediatric brain tumor surgery. Sodium fluorescein (SF) has been proposed as an adjunct to improve intraoperative visualization; however, evidence in pediatric populations is limited. This study evaluated the association between SF use and EOR, including the consistency of surgical outcomes. Methods A retrospective single-center cohort of 58 pediatric patients (19 SF, 39 control) with intended gross total resection (GTR) was analyzed. EOR was assessed using postoperative volumetric MRI. Given the retrospective design and histological heterogeneity, analyses were considered exploratory. Results The SF group showed greater mean EOR (99.67% ± 1.46 vs. 96.32% ± 11.53; p = 0.044), a higher GTR rate (94.7% vs. 61.5%; p = 0.011), and lower EOR dispersion (SD 1.46% vs. 11.53%; Levene's test p < 0.001). In exploratory histology-stratified analysis, these associations were mainly observed in pilocytic astrocytomas, whereas no relevant EOR difference was seen in non-pilocytic tumors. Conclusion SF-guided surgery was associated with a modestly greater extent of resection and significantly higher GTR rate in selected pediatric brain tumors, predominantly pilocytic astrocytomas, with reduced EOR dispersion as a secondary finding. Given the retrospective design, limited sample size, and potential confounding—including the post-hoc nature of the GTR comparison—these findings are hypothesis-generating.