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Fluorescence Imaging/Agents in Tumor Resection.

Walter Stummer1, Eric Suero Molina1

  • 1Department of Neurosurgery, Univerity Hospital Münster, Münster, Germany.

Neurosurgery Clinics of North America
|September 18, 2017
PubMed
Summary
This summary is machine-generated.

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.

Keywords:
5-Aminolevulnic acidFluoresceinFluorescence-guided resectionsGlioblastomaGliomas

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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.