Rodriguez Benjamin, Brown Cole S, Colan Jhair Alejandro, Zhang Jack Yin, Huq Sakibul, Rivera Daniel, Young Tirone, Williams Tyree, Subramaniam Varun, Hadjipanayis Constantinos
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Sinai BioDesign, Department of Neurosurgery, Mount Sinai, New York, NY 10029, USA.
Cancers (Basel). 2025 May 30;17(11):1837. doi: 10.3390/cancers17111837.
: Glioblastoma (GBM) is the most common primary malignant central nervous system tumor, accounting for 50.9% of malignant CNS diagnoses and carrying a median survival of 15 months despite maximal standard therapy. High recurrence rates are driven by residual infiltrative tumor cells at the resection margin. Fluorescence-guided surgery (FGS) has emerged as a key innovation to improve intraoperative tumor visualization and maximize the extent of resection (EOR). This review examines the historical development, current clinical applications, and future directions of FGS in GBM surgery. : A comprehensive literature review was conducted, covering the evolution of fluorophores (fluorescein, indocyanine green [ICG], and 5-aminolevulinic acid [5-ALA]), visualization technologies (wide- and narrow-field modalities), therapeutic adjuncts (photodynamic and sonodynamic therapies), and clinical adoption patterns and outcomes. : Early intraoperative fluorescence using fluorescein dates to 1947. ICG angiography has broad surgical utility, while 5-ALA received FDA approval in 2017, with phase III trials demonstrating gross total resection rates of 65% versus 36% with white-light surgery. Adjunct technologies-3D exoscopes, FGS-compatible loupes, and quantitative spectroscopy probes-enhance detection of residual tumor. Preliminary studies of intraoperative photodynamic and sonodynamic therapies show feasibility and potential survival benefits. Global adoption of 5-ALA FGS exceeds 75% among surveyed neurosurgeons. : FGS significantly improves EOR in GBM surgery, translating into better patient outcomes. Ongoing clinical trials and technological refinements-novel fluorophores, quantitative imaging, and therapeutic applications-promise to further optimize tumor visualization and treatment.
胶质母细胞瘤（GBM）是最常见的原发性恶性中枢神经系统肿瘤，占恶性中枢神经系统诊断病例的50.9%，尽管采用了最大标准治疗，其平均生存期仍为15个月。高复发率是由切除边缘残留的浸润性肿瘤细胞驱动的。荧光引导手术（FGS）已成为一项关键创新技术，可改善术中肿瘤可视化并最大化切除范围（EOR）。本综述探讨了FGS在GBM手术中的历史发展、当前临床应用及未来方向。：进行了全面的文献综述，涵盖了荧光团（荧光素、吲哚菁绿[ICG]和5-氨基乙酰丙酸[5-ALA]）的演变、可视化技术（广角和窄角模式）、治疗辅助手段（光动力和超声动力疗法）以及临床采用模式和结果。：术中早期使用荧光素的荧光可追溯到1947年。ICG血管造影术具有广泛的手术用途，而5-ALA于2017年获得美国食品药品监督管理局（FDA）批准，III期试验表明，与白光手术相比，其大体全切率为65%，而白光手术为36%。辅助技术——3D外视镜、与FGS兼容的放大镜和定量光谱探头——可增强对残留肿瘤的检测。术中光动力和超声动力疗法的初步研究显示了其可行性和潜在的生存益处。在接受调查的神经外科医生中，全球采用5-ALA FGS的比例超过75%。：FGS显著提高了GBM手术的EOR，从而带来更好的患者预后。正在进行的临床试验和技术改进——新型荧光团、定量成像和治疗应用——有望进一步优化肿瘤可视化和治疗。
