Fluorescence-guided neurosurgery—neuro-oncology and cerebrovascular applications (2019) by Constantinos G. Hadjipanayis and Walter Stummer (eds.)

Excerpt

Thieme-Verlag presents with the current volume Fluorescence-Guided Neurosurgery, an attractive book that illuminates the established techniques of fluorescence-enhanced intraoperative visualization during neurosurgical operations from different perspectives and also presents innovative approaches. The editors Constanios G. Hadjipanayis and Walter Stummer have succeeded in motivating a group of experts in the field to contribute to this multi-authored volume. The book consists of 20 chapters. After an introduction and a foreword, the first chapter outlines the technical basis of intraoperative fluorescence microscopy, and the established standard procedures with the fluorescent dyes 5-aminolevulinic acid (5-ALA), indocyanine green (ICG) and fluorescein are presented. Furthermore, possible improvements that could be imagined for the future are sketched here. In the following second chapter, Walter Stummer reviews the preconditions for conducting clinical studies and for certification of new medical devices and drugs. The following chapter provides a detailed overview of the established 5-aminolevulinic acid technique for high-grade glioma, especially with regard to the proven benefit for patients in terms of resection rate, better quality of life and longer survival time. The following chapters focus on the benefits of the 5-ALA technique for recurrent malignant glioma and on the potential application in low-grade gliomas, where the method has not been established as a standard yet, but apparently also could offer some benefit, provided methodological optimization. The following two chapters describe the application of the different fluorescence techniques, 5-ALA, ICG and fluorescein for meningiomas and brain metastases. The potential of 5-ALA fluorescence for surgery of cerebral metastases is discussed in detail and then also the potential of fluorescence techniques for spinal cord tumours, in particular the 5-ALA technique for ependymomas and astrocytomas, and the ICG technique for hemangioblastomas and cavernomas. Further chapters also shed light on the application of the 5-ALA method in paediatric brain tumours, and on the general impact of fluorescence-guided resection in neurosurgical oncology in general and specifically for the case of malignant gliomas. The remainder of the book deals with fluorescence methods that are still under development. The so-called second-window ICG method, in which the ICG bolus is given 24 h preoperatively, seems to have some potential for intraoperative visualization of malignant tumours. ICG allows for a better visualization of the deeper tissue layers than the 5-ALA method that permits a purely superficial visualization only. In the final chapters, new fluorescence dyes targeting tumour receptors are presented, which could allow for more selective and efficient visualization of tumour cells. The novel fluorescent, cancer-selective alkylphosphocholine analogues, CLR1501 (green) and CLR1502 (near infrared), seem to have much potential here at the moment. The current state of confocal microscopy and Raman spectroscopy for neurosurgical oncology is also analysed in detail. The importance of fluorescence microscopy is also compared to the merits of intraoperative neurophysiological monitoring and intraoperative MRI imaging in a separate chapter. The concluding reviews outline the value of ICG microscopy for vascular pathologies, saccular aneurysms, arteriovenous malformations and, finally, extra-intracranial bypass surgery. …