Background: Fluorescence-guided resection (FGR) of glioblastomas has been previously explored with the use of 5-amivelulinic acid (5-ALA) and sodium fluoresceine (SF), allowing us to maximize the extent of resection (EoR). In this study, we highlight the most relevant concerns regarding this technique and present the methods and results from the experience of our center. Methods: A case series of 100 patients operated on in AOU Città della Salute e della Scienza in Turin with a histological diagnosis of glioblastoma (grade IV, according to WHO 2021) was retrospectively analyzed. Both 5-ALA and SF were administered and intraoperatively assessed with an optical microscope. Results: 5-ALA is the only approved drug for FGR in glioblastoma, reporting an increased EoR. Nevertheless, SF can be positively used in addition to 5-ALA to reduce the risk of false positives without increasing the rate of adverse effects. In our experience, SF was used to guide the initial phase of resection while 5-ALA was used to visualize tumor spots within the surgical cavity. In 96% of cases, gross total resection was achieved, with supra-maximal resection in 11% of cases. Conclusions: Combined FGR using 5-ALA and SF seems to be a promising method of increasing the extent of resection and to improving the prognosis in glioblastoma patients.
背景：荧光引导下胶质母细胞瘤切除术（FGR）先前已通过使用5-氨基乙酰丙酸（5-ALA）和荧光素钠（SF）进行探索，使我们能够最大化切除范围（EoR）。在本研究中，我们重点探讨了该技术最相关的关注点，并介绍了我们中心的经验方法和结果。方法：对都灵AOU Città della Salute e della Scienza医院手术的100例经组织学诊断为胶质母细胞瘤（根据WHO 2021标准为IV级）的患者进行回顾性分析。所有患者均接受了5-ALA和SF的给药，并在术中使用光学显微镜进行评估。结果：5-ALA是唯一获批用于胶质母细胞瘤FGR的药物，报告显示其可提高切除范围。尽管如此，SF可作为5-ALA的补充，在不增加不良反应发生率的情况下降低假阳性风险。根据我们的经验，SF用于引导切除的初始阶段，而5-ALA用于显示手术腔内的肿瘤斑点。在96%的病例中实现了大体全切除，其中11%的病例实现了超全切除。结论：联合使用5-ALA和SF的FGR似乎是提高胶质母细胞瘤患者切除范围和改善预后的有前景的方法。
肿瘤(癌症)患者之家