Gabriel S. Gonzales-Portillo

Glioblastoma (GB) is among the most aggressive and difficult-to-treat brain tumors, with a median survival of only 12–15 months despite maximal treatments, including surgery, radiotherapy, and chemotherapy. Extensive surgical resection improves survival in glioblastoma patients; however, achieving complete resection is often hindered by limitations in neurosurgical guidance technologies for accurate tumor margin detection. Recent advancements in fluorescence-guided surgery (FGS) and imaging techniques have significantly enhanced the precision and extent of glioblastoma resections. This study evaluates the impact of NIR fluorescence imaging on tumor visualization, surgical precision, cost-effectiveness, and patient survival. A systematic review of PubMed, Scopus, Google Scholar, and Embase was conducted to identify studies on the role of NIR fluorescence in glioblastoma surgery. A total of 135 studies were included, comprising 10 reviews, three clinical studies, 10 randomized controlled trials (RCTs), 10 preclinical studies, and four case reports, all focused on NIR fluorescence imaging in glioblastoma surgery. The findings indicate that NIR fluorescence imaging significantly improves tumor visualization, resulting in an 18–22% increase in gross total resection (GTR) rates in clinical studies. NIR fluorescence provides continuous real-time feedback, minimizing repeat imaging, reducing operational costs, and increasing GTR. These improvements contribute to better patient outcomes, including extended progression-free survival, improved overall survival, and reduced postoperative neurological deficits. This review underscores the potential of NIR imaging to establish a new standard for intraoperative glioblastoma management.

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.