Visualization technologies for 5-ALA-based fluorescence-guided surgeries
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Introduction 5-ALA-based fluorescence-guided surgery has been shown to be a safe and effective method to improve intraoperative visualization and resection of malignant gliomas. However, it remains ineffective in guiding the resection of lower-grade, non-enhancing, and deep-seated tumors, mainly because these tumors do not produce detectable fluorescence with conventional visualization technologies, namely, wide-field (WF) surgical microscopy. Methods We describe some of the main factors that limit the sensitivity and accuracy of conventional WF surgical microscopy, and then provide a survey of commercial and research prototypes being developed to address these challenges, along with their principles, advantages and disadvantages, as well as the current status of clinical translation for each technology. We also provide a neurosurgical perspective on how these visualization technologies might best be implemented for guiding glioma surgeries in the future. Results Detection of PpIX expression in low-grade gliomas and at the infiltrative margins of all gliomas has been achieved with high-sensitivity probe-based visualization techniques. Deep-tissue PpIX imaging of up to 5 mm has also been achieved using red-light illumination techniques. Spectroscopic approaches have enabled more accurate quantification of PpIX expression. Conclusion Advancements in visualization technologies have extended the sensitivity and accuracy of conventional WF surgical microscopy. These technologies will continue to be refined to further improve the extent of resection in glioma patients using 5-ALA-induced fluorescence.
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Probe-based sectioning microscopes with red light illumination are able to provide high-resolution quantitative imaging of PpIX even in deep tissues.
“Probe-based sectioning microscopes with red light illumination are able to provide high-resolution quantitative imaging of PpIX even in deep tissues [81].”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [81]
The Deep-tissue imaging techniques section (page not provided) says high-resolution imaging is typically limited to about 100 microns of tissue depth. It attributes quantitative PpIX imaging several millimeters deep with red-light excitation to wide-field systems with about 1 mm spatial resolution, not to high-resolution probe-based sectioning microscopes. (LLM, conf=0.88)
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FLUORESCENT DYES IN MODERN NEUROSURGERY: TECHNOLOGICAL ADVANCES AND CLINICAL TRANSLATION
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- Authors
- Wei, L., Roberts, D. W., Sanai, N., & Liu, J. T. C.
- Affiliations
- University of Washington (US)
- Dartmouth College (US)
- Barrow Neurological Institute (US)
- Corresponding author
- Wei, Linpeng
- Venue
- Journal of Neuro-Oncology
- Published
- 2018-12-15
- Volume
- 141
- Issue
- 3
- Pages
- 495-505
- ISSN
- 0167-594X (ISSN-L)
- 1573-7373
- PMC
- PMC7707111
- OpenAlex
- W2903910008
- Cited by
- 67
- References
- 61
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 10 · 2023: 13 · 2022: 9 · 2021: 3 · 2020: 9 · 2019: 9
- FWCI
- 0.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Neuro-Oncology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Dental and Craniofacial Research (DE023497)
- National Cancer Institute (CA175391)
- National Institute of Neurological Disorders and Stroke (NS082745, NS052274)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Photodynamic Therapy Research Studies
- Keywords
- 5-aminolevulinic acid, fluorescence-guided surgery, high-grade glioma, protoporphyrin IX, low-grade glioma, red light illumination, tumor resection, intraoperative visualization, neurosurgery
- MeSH terms
- Aminolevulinic Acid, Brain Neoplasms, Fluorescent Dyes, Glioma, Humans, Neurosurgical Procedures, Surgery, Computer-Assisted, Optical Imaging
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