Xiang Yan, Zhu Xiao-Peng, Zhao Jian-Nong, Huang Guo-Hao, Tang Jun-Hai, Chen Huan-Ran, Du Lei, Zhang Dong, Tang Xue-Feng, Yang Hui, Lv Sheng-Qing
a Department of Neurosurgery , Xinqiao Hospital, Third Military Medical University , Chongqing , P.R. China.
b Department of Neurosurgery , Hainan General Hospital , Haikou , P.R. China.
Br J Neurosurg. 2018 Apr;32(2):141-148. doi: 10.1080/02688697.2018.1428731. Epub 2018 Jan 22.
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.
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.
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).
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.
荧光素钠（SF）是用于高级别胶质瘤（HGG）术中引导切除的理想染料。然而，SF引导技术是否适用于不同级别的胶质瘤尚不清楚，且荧光与病理之间的相关性也尚不明确。
在本研究中，我们调查了28例患者，包括23例HGG患者和5例低级别胶质瘤（LGG）患者。所有患者均在Pentero 900显微镜（德国奥伯科亨卡尔蔡司公司）上采用SF引导技术进行治疗。对肿瘤及瘤周组织进行紧密连接蛋白-5免疫组化（IHC）染色分析。
所有HGG术中均可见黄色荧光，而LGG中未见。HGG中血脑屏障内皮细胞中的紧密连接蛋白-5表达下调且连接中断（p < 0.05），而LGG中无差异或略有下降（p > 0.05）。
SF引导技术适用于HGG手术，但不适用于LGG手术。紧密连接蛋白-5表达下调可能是SF引导手术中胶质瘤出现黄色荧光的原因。
