Intraoperative fluorescent contrasting for primary and secondary brain tumors: literature review

Abstract

Relevance: The maximum possible removal of tumor tissue while preserving functionally significant areas of the brain remains one of the main goals of surgical removal of primary and secondary brain tumors. It is difficult to distinguish tumor tissue from normal brain tissue during surgery using traditional white light microscopy. Intraoperative fluorescent contrasting of brain tumors is used to overcome this limitation. The most studied fluorescent drugs are 5-aminolevulinic acid (5-ALA), Sodium Fluorescein, and Indocyanine green.

The study aimed to evaluate the experience of using intraoperative fluorescent contrast at the present stage, diagnostic capabilities, significance, application, and development prospects for primary and secondary brain tumors based on an analysis of literature data.

Methods: A systematic search of publications from the MEDLINE/PubMed database was conducted using keywords corresponding to the problem being studied related to fluorescent contrast in brain tumors with potential clinical significance. We selected and analyzed 33 publications for the study.

Results: According to the literature review, it can be seen that of the listed fluorescent drugs, 5-ALA is the most studied and approved for use for intraoperative fluorescent contrast of glial tumors of grade III and IV malignancy, which is reflected in the instructions for the use of the drug. The use of 5-ALA for the treatment of primary and secondary brain tumors of other histological structures is not indicated in the instructions for use; also, the instructions for use of sodium fluorescein and indocyanine green do not contain indications for use in the treatment of brain tumors, while the analysis of literature data showed a large experience of their successful use.

Conclusion: Fluorescent contrast of primary and secondary brain tumors is a new, promising, and insufficiently studied method of visualizing brain tumor tissue during surgery in real-time. Studying the possibilities and features of fluorescent contrasting primary and secondary brain tumors is a relevant and promising area of ​​study, and its implementation in practice will improve treatment results.