What aids are used to visualize glioblastoma multiforme (GBM) during surgery?

Updated: Jul 01, 2019
  • Author: Jeffrey N Bruce, MD; Chief Editor: Herbert H Engelhard, III, MD, PhD, FACS, FAANS  more...
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Answer

Oral aminolevulinic acid (ALA; Gleolan) was approved by the FDA in June 2017 as an adjunct for visualization of malignant tissue during surgery in patients with malignant glioma (suspected WHO grades III or IV on preoperative imaging). During surgery, an operating microscope adapted with a blue-emitting light source and filters for excitation light of wavelength 375-440 nm, and observation at wavelengths of 620-710 nm is used to visualize PpIX (an ALA metabolite) accumulation in tumor cells that shows up as red fluorescence. [115]

Fluorescence-guided surgery (FGS), an emerging technology that combines detection devices with fluorescent contrast agents, may provide more complete and precise resection of gliomas. Tozuleristide (BLZ-100), a near-infrared imaging agent composed of the peptide chlorotoxin and a near-infrared fluorophore indocyanine green, is a candidate for FGS of glioma and other tumor types. In a phase 1 study, tozuleristide (BLZ-100) provided a viable fluorescence signal in both high- and low-grade glial tumors, but did not bind to normal tissues. Signal intensity in high-grade tumors was found to improve with increasing doses of tozuleristide, regardless of the time of dosing relative to surgery. [116, 117]


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