Glioblastoma Multiforme (GBM) remains one of the most aggressive and challenging brain tumors to treat. Even with maximal treatment, the prognosis remains poor with low median survival. Extensive surgical resection is evidenced to increase glioblastoma life expectancy; however, complete resections are not usually achieved due to lack of sensitivity and the accuracy of margin neurosurgical guidance technologies. Recent advancements in fluorescence-guided surgery (FGS) and imaging techniques have helped enhance the precision and extent of glioblastoma resections. This study explores the impact of NIR fluorescence imaging on tumor visualization and surgical outcomes, including the extent of resection, cost-effectiveness, and patient survival.
A systematic search of PubMed, Scopus, Google Scholar, and Embase identified studies published on the effect of NIR on glioblastoma surgery. A total of 135 studies were included: 10 reviews, 3 clinical studies, 10 randomized controlled trials (RCTs), 10 preclinical studies, and 4 case reports, all focusing on the application of NIR fluorescence imaging in glioblastoma resection.
Our findings show that NIR fluorescence imaging significantly improved tumor visualization, leading to an 18-22% increase in gross total resection rates across clinical studies. Prolonged fluorescence provided continuous real-time feedback, reducing the need for repeat imaging, and lowering operational costs. Patient outcomes improved, including extended progression-free survival and overall survival, and fewer postoperative neurological deficits. This Review highlights the potential for the use of NIR imaging to become the new standard for intraoperative glioblastoma management.