11 Fluorescein and High-Grade Gliomas

As use of 5-aminolevulenic acid (5-ALA) in guiding resection of malignant glioma has been popularized, the search for other fluorescent agents has ensued. In this context, fluorescein sodium has arisen as an alternative and, in some cases, adjunct to 5-ALA, especially in countries where 5-ALA use is not approved. Fluorescein is inexpensive, safe, and easily implemented in practice and can be used with or without a dedicated microscope. Thus far, fluorescein has mainly been applied to resection of malignant gliomas, and numerous studies have been conducted assessing fluorescein’s utility in this context. This chapter will review fluorescein’s presumed mechanism of action for labeling tumor, existing evidence in support of its use in malignant glioma surgery, and evolving new applications of its use in oncologic neurosurgery.