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Trends in Fluorescence Image-Guided Surgery for Gliomas

Liu, Jonathan T.C. PhD*; Meza, Daphne BS*; Sanai, Nader MD

doi: 10.1227/NEU.0000000000000344

Mounting evidence suggests that a more extensive surgical resection is associated with an improved life expectancy for both low-grade and high-grade glioma patients. However, radiographically complete resections are not often achieved in many cases because of the lack of sensitivity and specificity of current neurosurgical guidance techniques at the margins of diffuse infiltrative gliomas. Intraoperative fluorescence imaging offers the potential to improve the extent of resection and to investigate the possible benefits of resecting beyond the radiographic margins. Here, we provide a review of wide-field and high-resolution fluorescence-imaging strategies that are being developed for neurosurgical guidance, with a focus on emerging imaging technologies and clinically viable contrast agents. The strengths and weaknesses of these approaches will be discussed, as well as issues that are being addressed to translate these technologies into the standard of care.

ABBREVIATIONS: 5-ALA, 5-aminolevulinic acid

BBB, blood-brain barrier

FIGS, fluorescence image-guided surgery

ICG, indocyanine green

LGG, low-grade glioma

PpIX, protoporphyrin IX

*Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York;

Barrow Brain Tumor Research Center, Division of Neurosurgical Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Correspondence: Nader Sanai, MD, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013. E-mail:

Received November 05, 2013

Accepted February 19, 2014

Copyright © by the Congress of Neurological Surgeons