Fluorescence Imaging/Agents in Tumor Resection

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Fluorescence Imaging/Agents in Tumor Resection Walter Stummer, Prof. Dr. med., Eric Suero Molina, Dr. med., MBA Neurosurgery Clinics Volume 28, Issue 4, Pages 569-583 (October 2017) DOI: 10.1016/j.nec.2017.05.009 Copyright © 2017 The Authors Terms and Conditions

Fig. 1 Hypothetical dependency of fluorescence in different tissue compartments on fluorochrome and time. (A) Metabolic (eg, ALA). Fluorochrome is in tumor cells and minimal or no fluorochrome is in normal tissue. (B) Passive permeability markers (fluorescein, ICG). Intravenous fluorochrome concentrations are first high in tissue and are extravasated within the tumor to give pseudoselectivity. Some fluorochrome propagates with edema or is released in areas of surgical damage. (C) Targeted fluorochromes behave as in passive permeability markers. Due to high affinity to tumor cells, these fluorochromes are selectively retained by tumor tissue. (D) Autofluorescence imaging. Signal remains unchanged over time. Neurosurgery Clinics 2017 28, 569-583DOI: (10.1016/j.nec.2017.05.009) Copyright © 2017 The Authors Terms and Conditions

Fig. 2 Preoperative and early postoperative MRI indicating resection volume of fluorescing tissue to exceed resection volume of enhancing tissue after fluorescence-guided resection using ALA. Neurosurgery Clinics 2017 28, 569-583DOI: (10.1016/j.nec.2017.05.009) Copyright © 2017 The Authors Terms and Conditions

Fig. 3 Intraoperative microscope view of fluorescence-guided resection of glioblastomas with ALA (A, B) and fluorescein (C, D), using white light (A, C) and fluorescing light (B, D), respectively. ALA accumulates specific in malignant glioma tissue, whereas fluorescein also appears in the dura, edematous brain, and regions of blood-brain barrier perturbation. Neurosurgery Clinics 2017 28, 569-583DOI: (10.1016/j.nec.2017.05.009) Copyright © 2017 The Authors Terms and Conditions