Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
World Neurosurg. 2014 Jul-Aug;82(1-2):175-85. doi: 10.1016/j.wneu.2013.06.014. Epub 2013 Jul 9.
Fluorescence guidance has a demonstrated potential in maximizing the extent of high-grade glioma resection. Different fluorophores (fluorescent biomarkers), including 5-aminolevulinic acid (5-ALA) and fluorescein, have been examined with the use of several imaging techniques. Our goal was to review the state of this technology and discuss strategies for more widespread adoption.
We performed a Medline search using the key words "fluorescence," "intraoperative fluorescence-guided resection," "intraoperative image-guided resection," and "brain glioma" for articles from 1960 until the present. This initial search revealed 267 articles. Each abstract and article was reviewed and the reference lists from select articles were further evaluated for relevance. A total of 64 articles included information about the role of fluorescence in resection of high-grade gliomas and therefore were selectively included for our analysis.
5-ALA and fluorescein sodium have shown promise as fluorescent markers in detecting residual tumor intraoperatively. These techniques have demonstrated a significant increase in the extent of tumor resection. Regulatory barriers have limited the use of 5-ALA and technological challenges have restricted the use of fluorescein and its derivatives in the United States. Limitations to this technology currently exist, such as the fact that fluorescence at tumor margins is not always reliable for identification of tumor-brain interface.
These techniques are safe and effective for increasing gross total resection. The development of more tumor-specific fluorophores is needed to resolve problems with subjective interpretation of fluorescent signal at tumor margins. Techniques such as quantum dots and polymer or iron oxide-based nanoparticles have shown promise as potential future tools.
荧光引导在最大限度地提高高级别脑胶质瘤切除术的范围方面具有明显的潜力。不同的荧光团（荧光生物标志物），包括 5-氨基乙酰丙酸（5-ALA）和荧光素，已经使用几种成像技术进行了检查。我们的目标是回顾该技术的现状，并讨论更广泛采用的策略。
我们使用“荧光”、“术中荧光引导切除”、“术中图像引导切除”和“脑胶质瘤”等关键词在 Medline 上进行了搜索，以查找 1960 年至今的文章。最初的搜索显示有 267 篇文章。我们对每个摘要和文章进行了审查，并进一步评估了选定文章的参考文献列表以确定相关性。共有 64 篇文章包含了荧光在高级别脑胶质瘤切除中的作用信息，因此被选择性地纳入我们的分析。
5-ALA 和荧光素钠已被证明是检测术中残留肿瘤的有前途的荧光标记物。这些技术已证明显著增加了肿瘤切除的范围。监管障碍限制了 5-ALA 的使用，技术挑战限制了荧光素及其衍生物在美国的使用。该技术目前存在一些局限性，例如肿瘤边缘的荧光并不总是可靠的肿瘤-脑界面的标识。
这些技术对于增加大体全切除是安全有效的。需要开发更多的肿瘤特异性荧光团，以解决荧光信号在肿瘤边缘的主观解释问题。量子点和聚合物或氧化铁基纳米粒子等技术已显示出作为潜在未来工具的前景。
