Maximal safe surgical resection remains a critical component of glioblastoma (GBM) management, improving both survival and quality of life. However, complete tumor removal is hindered by the infiltrative nature of GBM and its proximity to eloquent brain regions. Fluorescence-guided surgery (FGS) has emerged as a valuable tool to enhance intraoperative tumor visualization and optimize resection outcomes. Currently used fluorophores such as 5-aminolevulinic acid (5-ALA), fluorescein sodium (FS), and indocyanine green (ICG) have distinct advantages but are limited by suboptimal specificity, shallow tissue penetration, and technical constraints. 5-ALA and SF often yield unreliable signals in low-grade tumors or infiltrative regions and also pose challenges such as phototoxicity and poor depth resolution. In contrast, near-infrared (NIR) fluorescence imaging represents a promising next-generation approach, providing superior tissue penetration, reduced autofluorescence, and real-time delineation of tumor margins. This review explores the mechanisms, clinical applications, and limitations of currently approved FGS agents and highlights future directions in image-guided neurosurgery.
最大限度安全手术切除仍是胶质母细胞瘤治疗的关键环节，可同时改善患者生存期与生活质量。然而，肿瘤的浸润性生长特性及其与脑功能区的毗邻关系阻碍了完全切除的实现。荧光引导手术作为一种增强术中肿瘤可视化、优化切除效果的重要工具应运而生。目前临床应用的荧光剂如5-氨基乙酰丙酸、荧光素钠和吲哚菁绿虽各具优势，但均存在特异性不足、组织穿透深度有限及技术限制等问题。5-氨基乙酰丙酸与荧光素钠在低级别胶质瘤或浸润区域常产生不可靠信号，同时存在光毒性及深度分辨率不足等挑战。相比之下，近红外荧光成像技术展现出新一代方法的潜力，其具备更优的组织穿透性、更低的自发荧光干扰，并能实现肿瘤边界的实时显影。本文系统综述了当前获批荧光引导手术试剂的显像机制、临床应用及局限性，并对影像引导神经外科的未来发展方向进行展望。
Current and Emerging Fluorescence-Guided Techniques in Glioma to Enhance Resection
肿瘤(癌症)患者之家