Wei Linpeng, Fujita Yoko, Sanai Nader, Liu Jonathan T C
Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ, United States.
Front Oncol. 2019 Jul 3;9:592. doi: 10.3389/fonc.2019.00592. eCollection 2019.
Low-power fluorescence microscopy of 5-ALA-induced PpIX has emerged as a valuable intraoperative imaging technology for improving the resection of malignant gliomas. However, current fluorescence imaging tools are not highly sensitive nor quantitative, which limits their effectiveness for optimizing operative decisions near the surgical margins of gliomas, in particular non-enhancing low-grade gliomas. Intraoperative high-resolution optical-sectioning microscopy can potentially serve as a valuable complement to low-power fluorescence microscopy by providing reproducible quantification of tumor parameters at the infiltrative margins of diffuse gliomas. In this forward-looking perspective article, we provide a brief discussion of recent technical advancements, pilot clinical studies, and our vision of the future adoption of handheld optical-sectioning microscopy at the final stages of glioma surgeries to enhance the extent of resection. We list a number of challenges for clinical acceptance, as well as potential strategies to overcome such obstacles for the surgical implementation of these microscopy techniques.
5-氨基乙酰丙酸（5-ALA）诱导的原卟啉IX（PpIX）的低倍荧光显微镜检查已成为一种有价值的术中成像技术，可用于改善恶性胶质瘤的切除效果。然而，目前的荧光成像工具既不高度敏感也不具备定量功能，这限制了它们在优化胶质瘤手术边缘（特别是无强化的低级别胶质瘤）手术决策方面的有效性。术中高分辨率光学切片显微镜检查通过对弥漫性胶质瘤浸润边缘的肿瘤参数进行可重复定量，有可能成为低倍荧光显微镜检查的重要补充。在这篇前瞻性观点文章中，我们简要讨论了近期的技术进展、初步临床研究，以及我们对在胶质瘤手术最后阶段采用手持式光学切片显微镜以提高切除范围的未来展望。我们列出了临床接受方面的一些挑战，以及克服这些障碍以实现这些显微镜技术手术应用的潜在策略。
