Intra-operative Use of Indigo Carmine Dye for the Delineation of Ill Defined Tumor Borders Using Stereotactic Injection

Low grade gliomas are brain tumors with usually poorly defined borders between tumor and normal brain. This characteristic of low grade gliomas makes the gross total resection of the tumor extremely difficult. Nevertheless, several studies have demonstrated that the risk of recurrence and progression into a more malignant tumor can be decreased with a more aggressive surgical resection. An aggressive attempt to achieve a gross total resection may result in the resection of normal brain and therefore neurological injury. For this reason, the more common error is to subtotally resect the tumor leaving significant volumes of tumor behind. Many techniques have been introduced to safely increase the extent of resection, since the extent of resection is associated with a higher survival rate. Each one of these techniques has several shortcomings. The current study will assess whether the intraoperative stereotactic injection of the indigo carmine at the tumor margins helps to safely increase of extent of tumor resection. In the first step of the study the safety and the correlation between resection of stained tissue/extend of tumor resection will be assessed. If the results are satisfactory, then the second step will ensue. In the second step we will assess the utility of indigo carmine as an additional adjunct to guide tumor resection.

• Indigo carmine (Drug), also known as Indigotindisulfonate sodium: During resection, a small quantity of a special dye called indigo carmine will be infused at the margins of the tumor using computer-guided stereotactic navigation equipment. This dye will be visible during the tumor resection and it can potentially serve as an additional marker of the tumor margins. A post-operative MRI scan -which is part of the standard care- will accurately measure the extent of tumor resection.

Primary outcomes

• Extent of Resection [48 hours]: Evaluation of the extent of resection of the tumor following the indigo carmine infusion to the tumor.

Secondary outcomes

• Absence of Complications After Injection [30 days]: Assessment of Post-operative Clinical Course \& Complications

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Subjects with gliomas or other tumors that may have ill defined margins during the operative resection.

Exclusion Criteria:

* Subjects with a contraindication for brain MRI scan. Subjects who are pregnant, younger than 18 years old or have a contraindication for indigo carmine are excluded as well

Participant flow

Outcome results

• Extent of Resection (Primary), Mean, percentage of tumor resected: Indigo Carmine 97.1 (91 to 100)
• Absence of Complications After Injection (Secondary), Count of participants, Participants: Indigo Carmine 1

Adverse events

Serious adverse events by term

Other adverse events by term

• Theodore Schwartz, MD, Principal investigator, Weill Medical College of Cornell University