Romeo Eleni, Tzakos Andreas G, Crook Timothy, Syed Nelofer, Voulgaris Spyridon, Alexiou George A
Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece.
Department of Neurosurgery, School of Medicine, University of Ioannina, 45500 Ioannina, Greece.
Pharmaceutics. 2025 May 11;17(5):637. doi: 10.3390/pharmaceutics17050637.
Glioblastoma (GBM) is the most aggressive primary brain tumor, characterized by rapid progression and a median survival of no more than 12-18 months. Fluorescence-guided surgery is crucial, as it allows for tumor visualization and aids in its complete removal, which is essential for improving survival rates. We conducted a literature review to identify fluorescent agents that have been utilized in the removal of GBM and to assess their benefits in achieving maximum tumor resection. Our analysis focuses on their advantages, limitations, and potential impact on improving surgical precision and patient outcomes. We searched the PubMed database for studies published on fluorescence-guided resection of GBM and evaluated the utility of each agent in terms of outcomes, gross total resection (GTR), and their sensitivity and specificity for the tumor. The literature review revealed that the three agents successfully utilized are 5-aminolevulinic acid (5-ALA), sodium fluorescein, and indocyanine green. In addition to these, a variety of dyes have been investigated in studies, including peptides, lipids, and nanosystems, which appear to be very promising. To date, numerous fluorescent agents have been proposed for the surgical resection of GBM. However, 5-aminolevulinic acid (5-ALA) remains the only agent widely adopted in clinical practice, as its safety and efficacy have been well-established. Further clinical trials and studies are necessary to assess the utility, effectiveness, and potential advantages of emerging fluorescent dyes in enhancing GBM resection and improving patient outcomes.
胶质母细胞瘤（GBM）是最具侵袭性的原发性脑肿瘤，其特征为进展迅速，中位生存期不超过12 - 18个月。荧光引导手术至关重要，因为它能使肿瘤可视化并有助于将其完整切除，这对于提高生存率至关重要。我们进行了一项文献综述，以确定已用于GBM切除的荧光剂，并评估它们在实现最大程度肿瘤切除方面的益处。我们的分析聚焦于它们的优势、局限性以及对提高手术精度和患者预后的潜在影响。我们在PubMed数据库中搜索关于GBM荧光引导切除术的已发表研究，并根据结果、大体全切（GTR）以及它们对肿瘤的敏感性和特异性来评估每种试剂的效用。文献综述显示，成功使用的三种试剂是5 - 氨基乙酰丙酸（5 - ALA）、荧光素钠和吲哚菁绿。除此之外，研究中还考察了多种染料，包括肽、脂质和纳米系统，它们似乎非常有前景。迄今为止，已提出许多荧光剂用于GBM的手术切除。然而，5 - 氨基乙酰丙酸（5 - ALA）仍然是临床实践中唯一广泛采用的试剂，因为其安全性和有效性已得到充分证实。需要进一步的临床试验和研究来评估新型荧光染料在增强GBM切除和改善患者预后方面的效用、有效性和潜在优势。
