title: Fluorescence in neurosurgery: Its diagnostic and therapeutic use. Review of the literature.
abstract: Fluorescent agents, e.g. 5-aminolevulinic acid (5-ALA), fluorescein and indocyanine green (ICG) are in common use in neurosurgery for tumor resection and neurovascular surgery. Protoporphyrine IX (PPIX) as major metabolite of 5-ALA is a strong fluorescent substance accumulated within malignant glioma tissue and a very sensitive and specific tool for visualizing high grade glioma tissue during surgery. Furthermore, 5-ALA or rather PPIX also offers an intratumoral therapeutic option stimulated by laser light in specific wavelength. Fluorescein was demonstrated to show similar fluorescent reactions in neurosurgery, but is controversial in its use, especially in high grade tumor surgery. Intraoperative angiography during resection of arterio-venous malformations, extracranial-intracranial-bypass or aneurysm surgery is supported by ICG fluorescence. Generally ICG will provide beneficial information for both, exposure of the pathology and illustration of healthy structures. This manuscript shows an overview of the literature focussing fluorescence in neurosurgery.
authors.affiliation: Department of Neurosurgery, University Hospital, Münster, Germany. Electronic address: christian.ewelt@ukmuenster.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Ewelt
authors.affiliation: Institute of Neuropathology, University Hospital, Münster, Germany.
authors.forename: Andrei
authors.initials: A
authors.lastname: Nemes
authors.affiliation: Institute of Neuropathology, University Hospital, Münster, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Senner
authors.affiliation: Department of Neurosurgery, University Hospital, Münster, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wölfer
authors.affiliation: Department of Neurosurgery, University Hospital, Münster, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Brokinkel
authors.affiliation: Department of Neurosurgery, University Hospital, Münster, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Stummer
authors.affiliation: Department of Neurosurgery, University Hospital, Münster, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Holling
mesh_terms: D000622:Aminolevulinic Acid / Q000737:chemistry* / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005910:Glioma / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007208:Indocyanine Green / Q000737:chemistry / Q000627:therapeutic use; D061848:Optical Imaging; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000737:chemistry* / Q000627:therapeutic use; D011524:Protoporphyrins / Q000737:chemistry* / Q000627:therapeutic use
chemical_list: D017319:Photosensitizing Agents; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; D007208:Indocyanine Green
keywords: 5-aminolevulinic acid; Brain tumors; Fluorescein; Indocyanin green; Intraoperative angiography