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Systematic Review

Fluorescence-Guided Surgical Techniques in Adult Diffuse Low-Grade Gliomas: State-of-the-Art and Emerging Techniques: A Systematic Review

1
Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
2
Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France
3
Cancer Research Centre of Lyon (CRCL) Inserm 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
4
Laboratoire Hubert Curien UMR 5516, Institut d’Optique Graduate School, CNRS, Université Jean Monnet Saint-Etienne, 42023 Saint-Etienne, France
5
CREATIS CNRS, Inserm, UMR 5220, U1294, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, 69100 Lyon, France
*
Authors to whom correspondence should be addressed.
Cancers 2024, 16(15), 2698; https://doi.org/10.3390/cancers16152698
Submission received: 28 June 2024 / Revised: 26 July 2024 / Accepted: 28 July 2024 / Published: 29 July 2024
(This article belongs to the Special Issue Neurosurgical Management of Gliomas)

Simple Summary

In the era of targeted therapies, achieving a maximal safe resection still remains a critical prognosis factor in diffuse low-grade gliomas and represents the goal to reach for neurosurgeons who manage these tumors. Whereas fluorescence-guided surgery, using 5-aminolevulinic acid or even fluorescein sodium significantly increases the extent of resection of high-grade gliomas, its relevance for the resection of low-grade gliomas is very limited. However, new intraoperative techniques such as spectroscopic detection of 5-aminolevulinic acid-induced fluorescence or confocal laser endomicroscopy have been developed in order to increase the sensitivity of fluorescence detection in low-grade gliomas or to generate optic biopsies, respectively. Therefore, the goal of this review was to sum up the limitations of macroscopic fluorescence detection in low-grade gliomas and to highlight how new technologies likely to be implemented in the surgical routine in the near future, could overcome these limitations.

Abstract

Diffuse low-grade gliomas are infiltrative tumors whose margins are not distinguishable from the adjacent healthy brain parenchyma. The aim was to precisely examine the results provided by the intraoperative use of macroscopic fluorescence in diffuse low-grade gliomas and to describe the new fluorescence-based techniques capable of guiding the resection of low-grade gliomas. Only about 20% and 50% of low-grade gliomas are macroscopically fluorescent after 5-amino-levulinic acid (5-ALA) or fluorescein sodium intake, respectively. However, 5-ALA is helpful for detecting anaplastic foci, and thus choosing the best biopsy targets in diffuse gliomas. Spectroscopic detection of 5-ALA-induced fluorescence can detect very low and non-macroscopically visible concentrations of protoporphyrin IX, a 5-ALA metabolite, and, consequently, has excellent performances for the detection of low-grade gliomas. Moreover, these tumors have a specific spectroscopic signature with two fluorescence emission peaks, which is useful for distinguishing them not only from healthy brain but also from high-grade gliomas. Confocal laser endomicroscopy can generate intraoperative optic biopsies, but its sensitivity remains limited. In the future, the coupled measurement of autofluorescence and induced fluorescence, and the introduction of fluorescence detection technologies providing a wider field of view could result in the development of operator-friendly tools implementable in the operative routine.
Keywords: 5-ALA; biopsy; confocal laser endomicroscopy; fluorescein sodium; fluorescence-guided resection; diffuse low-grade gliomas; spectroscopy 5-ALA; biopsy; confocal laser endomicroscopy; fluorescein sodium; fluorescence-guided resection; diffuse low-grade gliomas; spectroscopy

Share and Cite

MDPI and ACS Style

Picart, T.; Gautheron, A.; Caredda, C.; Ray, C.; Mahieu-Williame, L.; Montcel, B.; Guyotat, J. Fluorescence-Guided Surgical Techniques in Adult Diffuse Low-Grade Gliomas: State-of-the-Art and Emerging Techniques: A Systematic Review. Cancers 2024, 16, 2698. https://doi.org/10.3390/cancers16152698

AMA Style

Picart T, Gautheron A, Caredda C, Ray C, Mahieu-Williame L, Montcel B, Guyotat J. Fluorescence-Guided Surgical Techniques in Adult Diffuse Low-Grade Gliomas: State-of-the-Art and Emerging Techniques: A Systematic Review. Cancers. 2024; 16(15):2698. https://doi.org/10.3390/cancers16152698

Chicago/Turabian Style

Picart, Thiebaud, Arthur Gautheron, Charly Caredda, Cédric Ray, Laurent Mahieu-Williame, Bruno Montcel, and Jacques Guyotat. 2024. "Fluorescence-Guided Surgical Techniques in Adult Diffuse Low-Grade Gliomas: State-of-the-Art and Emerging Techniques: A Systematic Review" Cancers 16, no. 15: 2698. https://doi.org/10.3390/cancers16152698

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