Current and Emerging Fluorescence-Guided Techniques in Glioma to Enhance Resection.

Area of Science:

• Neurosurgery
• Oncology
• Medical Imaging

Background:

• Maximal safe surgical resection is vital for glioblastoma (GBM) management, improving survival and quality of life.
• Glioblastoma's infiltrative nature and proximity to eloquent brain regions challenge complete tumor removal.
• Fluorescence-guided surgery (FGS) aids intraoperative tumor visualization to optimize resection.

Purpose of the Study:

• To review current fluorescence-guided surgery (FGS) agents for glioblastoma (GBM).
• To explore limitations of existing FGS agents and highlight near-infrared (NIR) fluorescence imaging as a next-generation approach.
• To discuss future directions in image-guided neurosurgery for improved GBM resection.

Main Methods:

• Review of current literature on fluorescence-guided surgery (FGS) agents.
• Analysis of mechanisms, clinical applications, and limitations of approved FGS agents (5-ALA, FS, ICG).
• Exploration of near-infrared (NIR) fluorescence imaging principles and advantages.

Main Results:

• Current FGS agents (5-ALA, FS, ICG) have limitations including suboptimal specificity, shallow penetration, and technical constraints.
• 5-ALA and FS can yield unreliable signals in infiltrative tumors and pose challenges like phototoxicity.
• Near-infrared (NIR) fluorescence imaging offers superior tissue penetration, reduced autofluorescence, and real-time tumor margin delineation.

Conclusions:

• Next-generation near-infrared (NIR) fluorescence imaging shows significant promise for enhancing glioblastoma (GBM) resection.
• Optimizing FGS agents is critical for improving surgical outcomes in GBM management.
• Future research should focus on developing advanced imaging techniques for image-guided neurosurgery.