Mansour Hadeel M, Shah Siddharth, Aguilar Tania M, Abdul-Muqsith Mohammed, Gonzales-Portillo Gabriel S, Mehta Ankit I
Department of Neurosurgery, University of Illinois Chicago, Chicago, IL 60612, USA.
Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA.
Cancers (Basel). 2024 Nov 27;16(23):3984. doi: 10.3390/cancers16233984.
Glioblastoma (GB) is among the most aggressive and difficult-to-treat brain tumors, with a median survival of only 12-15 months despite maximal treatments, including surgery, radiotherapy, and chemotherapy. Extensive surgical resection improves survival in glioblastoma patients; however, achieving complete resection is often hindered by limitations in neurosurgical guidance technologies for accurate tumor margin detection. Recent advancements in fluorescence-guided surgery (FGS) and imaging techniques have significantly enhanced the precision and extent of glioblastoma resections. This study evaluates the impact of NIR fluorescence imaging on tumor visualization, surgical precision, cost-effectiveness, and patient survival. A systematic review of PubMed, Scopus, Google Scholar, and Embase was conducted to identify studies on the role of NIR fluorescence in glioblastoma surgery. A total of 135 studies were included, comprising 10 reviews, three clinical studies, 10 randomized controlled trials (RCTs), 10 preclinical studies, and four case reports, all focused on NIR fluorescence imaging in glioblastoma surgery. The findings indicate that NIR fluorescence imaging significantly improves tumor visualization, resulting in an 18-22% increase in gross total resection (GTR) rates in clinical studies. NIR fluorescence provides continuous real-time feedback, minimizing repeat imaging, reducing operational costs, and increasing GTR. These improvements contribute to better patient outcomes, including extended progression-free survival, improved overall survival, and reduced postoperative neurological deficits. This review underscores the potential of NIR imaging to establish a new standard for intraoperative glioblastoma management.
胶质母细胞瘤（GB）是最具侵袭性且最难治疗的脑肿瘤之一，尽管采用了包括手术、放疗和化疗在内的最大程度治疗，其平均生存期也仅为12 - 15个月。广泛的手术切除可提高胶质母细胞瘤患者的生存率；然而，由于用于精确检测肿瘤边缘的神经外科引导技术存在局限性，往往难以实现完全切除。荧光引导手术（FGS）和成像技术的最新进展显著提高了胶质母细胞瘤切除术的精度和范围。本研究评估了近红外荧光成像对肿瘤可视化、手术精度、成本效益和患者生存的影响。对PubMed、Scopus、谷歌学术和Embase进行了系统综述，以确定关于近红外荧光在胶质母细胞瘤手术中作用的研究。共纳入135项研究，包括10篇综述、3项临床研究、10项随机对照试验（RCT）、10项临床前研究和4例病例报告，所有研究均聚焦于胶质母细胞瘤手术中的近红外荧光成像。研究结果表明，近红外荧光成像显著改善了肿瘤可视化，在临床研究中使大体全切除（GTR）率提高了18 - 22%。近红外荧光提供连续实时反馈，减少重复成像，降低手术成本，并提高GTR。这些改善有助于改善患者预后，包括延长无进展生存期、提高总生存期和减少术后神经功能缺损。本综述强调了近红外成像为术中胶质母细胞瘤管理建立新标准的潜力。
