Intraoperative fluorescence redefining neurosurgical precision

Area of Science:

• Neurosurgery
• Medical Imaging
• Oncology

Background:

• Surgical resection is crucial for solid tumors, but achieving complete tumor removal while preserving healthy tissue is challenging in neurosurgery.
• Limitations in visualizing tumor margins with traditional methods lead to incomplete resections (90% recurrence for gliomas) or iatrogenic nerve damage (8% incidence).
• There is a critical need for advanced intraoperative techniques to accurately identify lesion margins and nerves.

Purpose of the Study:

• To review current fluorescent imaging modalities in neurosurgery.
• To highlight the benefits and limitations of existing fluorescence-guided surgery (FGS) agents.
• To introduce novel nerve-targeted probes for improved visualization.

Main Methods:

• Assessment of major fluorescent imaging modalities used in neurosurgery.
• Evaluation of the sensitivity and specificity of current fluorescent agents.
• Review of the potential of novel nerve-targeted probes, such as Nerve Peptide 41.

Main Results:

• Current FGS agents like 5-aminolevulinic acid and indocyanine green have limitations in selectivity, sensitivity, and specificity.
• Existing agents do not adequately address the need for precise nerve visualization during surgery.
• Nerve Peptide 41 is presented as a promising novel probe for systemically administered, nerve-targeted fluorescence imaging.

Conclusions:

• Improved intraoperative visualization is essential to reduce tumor recurrence and iatrogenic nerve injury in neurosurgery.
• While FGS has advanced visualization, limitations persist.
• Novel nerve-targeted fluorescent probes like Nerve Peptide 41 offer potential solutions for enhanced precision in neurosurgical procedures.