The recent FDA approval of 5-aminolevulinic acid (5-ALA)/protoporphyrin IX (PpIX) for fluorescence-guided resection of gliomas has significantly improved surgeons’ ability to identify and remove bulk high-grade tumors using widefield imaging. However, the limited sensitivity of widefield fluorescence imaging makes it challenging to identify regions of sparse and low fluorophore accumulation, such as in low-grade gliomas and at the diffuse margins of all gliomas. Here we describe several improvements on a handheld confocal microscope designed to detect sparse PpIX fluorescence in vivo, with the goal of providing a quantitative method to guide glioma resections.
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