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Published on: September 19, 2014
Fluorescence Imaging/Agents in Tumor Resection
Walter Stummer1, Eric Suero Molina1
1Department of Neurosurgery, Univerity Hospital Münster, Münster, Germany.
Abstract:
Intraoperative fluorescence imaging allows real-time identification of diseased tissue during surgery without being influenced by brain shift and surgery interruption. 5-Aminolevulinic acid, useful for malignant gliomas and other tumors, is the most broadly explored compound approved for fluorescence-guided resection. Intravenous fluorescein sodium has recently received attention, highlighting tumor tissue based on extravasation at the blood-brain barrier (defective in many brain tumors). Fluorescein in perfused brain, unselective extravasation in brain perturbed by surgery, and propagation with edema are concerns. Fluorescein is not approved but targeted fluorochromes with affinity to brain tumor cells, in development, may offer future advantages.
Insights
Intraoperative fluorescence imaging aids real-time identification of diseased brain tissue during surgery. While 5-aminolevulinic acid is approved, fluorescein sodium highlights tumors but has limitations, with targeted fluorochromes showing future promise.
Area of Science:
- Neurosurgery
- Oncology
- Medical Imaging
Background:
- Intraoperative fluorescence imaging offers real-time visualization of diseased tissue, unaffected by brain shift or surgical interruptions.
- 5-Aminolevulinic acid (5-ALA) is an approved compound widely used for fluorescence-guided resection, particularly in malignant gliomas.
- Intravenous fluorescein sodium is emerging as an alternative, identifying tumors via blood-brain barrier extravasation.
Purpose of the Study:
- To review the current landscape of intraoperative fluorescence imaging agents for brain tumor surgery.
- To compare the utility and limitations of 5-ALA and fluorescein sodium.
- To discuss potential future developments in fluorescence-guided resection.
Main Methods:
- Review of existing literature on intraoperative fluorescence imaging agents.
- Analysis of the mechanisms of action, advantages, and disadvantages of 5-ALA and fluorescein sodium.
- Discussion of emerging targeted fluorochromes.
Main Results:
- 5-Aminolevulinic acid is an established agent for fluorescence-guided resection of brain tumors.
- Fluorescein sodium effectively highlights tumor tissue by exploiting blood-brain barrier defects but faces challenges like non-specific extravasation and edema propagation.
- Current limitations of fluorescein sodium necessitate further research and development.
Conclusions:
- Intraoperative fluorescence imaging is a valuable tool for enhancing surgical precision in brain tumor resection.
- While 5-ALA is approved and effective, fluorescein sodium presents an alternative with specific concerns.
- Development of targeted fluorochromes with tumor cell affinity holds significant potential for future advancements in fluorescence-guided surgery.
