Pediatric Low-Grade Glioma Surgery with Sodium Fluorescein: Efficient Localization for Removal and Association with Intraoperative Pathological Sampling

Round 1

Reviewer 1 Report

These authors report on their experience with sodium fluorescein in the resection of pediatric low grade gliomas.

 

1)    The introduction can be shortened.

 

2)    The authors describe a qualitative grading scale.  Can they provide more detail on how this was determined?  Are there representative images they can show?  What was the inter-rater reliability?

 

3)    The authors also measured fluorescence quantitatively.  If fluorescence was measured quantitatively, why was a qualitative assessment also included, especially as there seems to be little correlation between the surgeons’ assessments and the measurement?

 

4)    What was the criteria for grading degree of enhancement as +++, ++, or +?  Are there representative images?  Was quantitative data collected?  Who reviewed the images, what was their training?  If more than one reviewer was used, what was the inter-rater reliability? 

 

5)    I am unsure what the utility is of defining “informative” EPS as providing a definitive diagnosis.  It seems that the most useful answer a pathologist could provide is simply “tumor” or “not tumor.”

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Interesting and well written study regarding Pediatric low grade gliomas surgery with sodium fluorescein, with a focus on efficient localization for removal and association with intraoperative pathological sampling. 

Introduction: nothing to concern. 

M&M: well explained.

Results: well presented and complete.

Discussion: Just a minor comment - could you please comment about the possibility of combining fluorescence with ultrasonography to increase tumor resection (eg: Della Pepa GM et al. "Dark corridors" in 5-ALA resection of high-grade gliomas: combining fluorescence-guided surgery and contrast-enhanced ultrasonography to better explore the surgical field. J Neurosurg Sci. 2019 Dec;63(6):688-696. doi: 10.23736/S0390-5616.19.04862-8. PMID: 31961118.)   ? 

Conclusion: effective and concise 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

The authors well explored the efficient localization for removal and association with intraoperative pathological sampling

Author Response

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Author Response File: Author Response.pdf