5-ALA-based fluorescence-guided surgery (FGS) is a state-of-the-art treatment for brain tumors, but may miss areas due to its low sensitivity. To improve the sensitivity we developed dual PpIX and Moxifloxacin Fluorescence Confocal Imaging method that allows simultaneous imaging of 5-ALA and moxifloxacin by excitation with a single light source. This method verified by comparing confocal images in glioblastoma specimen. The distribution of cells expressing 5-ALA and moxifloxacin fluorescence signals showed the same correlation. In large-area tumor sample images, PplX showed differences in signal intensity, but moxifloxacin was constant. These results show the potential to improve sensitivity than with 5-ALA alone.
Surgical resection is the primary treatment for malignant brain tumors. This procedure has a dilemma—aggressive surgical resection tends to extend patient survival; however, it also increases the risk of neurological deficiencies. Current medical imaging methods are not sensitive and their interpretation largely depend on surgeon’s impression. High-speed cellular imaging method by using clinically applicable moxifloxacin was demonstrated for fast and sensitive tumor-detection. The detailed cytoarchitecture of brain tumor mouse model and malignant human brain tumors was revealed. This study showed the potential and feasibility of moxifloxacin-based confocal microscopy as a surgery-guiding method for tumor removal.
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