Glioblastoma (GBM) is the most common primary brain tumor with a dismal prognosis. Current standard of treatment is safe maximal tumor resection followed by chemotherapy and radiation. Altered cerebral microcirculation and elevated blood‐tumor barrier (BTB) permeability in tumor periphery due to glioma‐induced vascular dysregulation allow T1 contrast‐enhanced visualization of resectable tumor boundaries. Newer tracers that label the tumor and its vasculature are being increasingly used for intraoperative delineation of glioma boundaries for even more precise resection. Fluorescent 5‐aminolevulinic acid (5‐ALA) and indocyanine green (ICG) are examples of such intraoperative tracers. Recently, magnetic resonance imaging (MRI)–based MR thermometry is being employed for laser interstitial thermal therapy (LITT) for glioma debulking. However, aggressive, fatal recurrence always occurs. Postsurgical chemotherapy is hampered by the inability of most drugs to cross the blood‐brain barrier (BBB). Understanding postsurgical changes in brain microcirculation and permeability is crucial to improve chemotherapy delivery. It is important to understand whether any microcirculatory indices can differentiate between true recurrence and radiation necrosis. LITT leads to peri‐ablation BBB opening that persists for several weeks. Whether it can be a conduit for chemotherapy delivery is yet to be explored. This review will address the role of cerebral microcirculation in such emerging ideas in GBM diagnosis and therapy.

中文翻译：

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胶质母细胞瘤的脑微循环：诊断、切除和药物输送的主要决定因素

胶质母细胞瘤 (GBM) 是最常见的原发性脑肿瘤，预后不佳。目前的治疗标准是安全的最大肿瘤切除术，然后是化学疗法和放射疗法。由于胶质瘤引起的血管失调，脑微循环改变和肿瘤外周血肿瘤屏障 (BTB) 通透性升高，使得可切除肿瘤边界的 T1 对比增强可视化成为可能。标记肿瘤及其脉管系统的新型示踪剂正越来越多地用于术中描绘神经胶质瘤边界，以实现更精确的切除。荧光 5-氨基乙酰丙酸 (5-ALA) 和吲哚菁绿 (ICG) 就是此类术中示踪剂的例子。最近，基于磁共振成像 (MRI) 的 MR 体温计正被用于激光间质热疗法 (LITT) 以去除胶质瘤。然而，侵略性，致命的复发总是发生。大多数药物无法通过血脑屏障 (BBB) 阻碍了术后化疗。了解脑微循环和通透性的术后变化对于改善化疗给药至关重要。重要的是要了解是否有任何微循环指标可以区分真正的复发和放射性坏死。LITT 导致持续数周的消融期 BBB 开放。它是否可以成为化疗给药的渠道还有待探索。本综述将探讨脑微循环在 GBM 诊断和治疗中这些新兴思想中的作用。了解脑微循环和通透性的术后变化对于改善化疗给药至关重要。重要的是要了解是否有任何微循环指标可以区分真正的复发和放射性坏死。LITT 导致持续数周的消融期 BBB 开放。它是否可以成为化疗给药的渠道还有待探索。本综述将探讨脑微循环在 GBM 诊断和治疗中这些新兴思想中的作用。了解脑微循环和通透性的术后变化对于改善化疗给药至关重要。重要的是要了解是否有任何微循环指标可以区分真正的复发和放射性坏死。LITT 导致持续数周的消融期 BBB 开放。它是否可以成为化疗给药的渠道还有待探索。本综述将探讨脑微循环在 GBM 诊断和治疗中这些新兴思想中的作用。它是否可以成为化疗给药的渠道还有待探索。本综述将探讨脑微循环在 GBM 诊断和治疗中这些新兴思想中的作用。它是否可以成为化疗给药的渠道还有待探索。本综述将探讨脑微循环在 GBM 诊断和治疗中这些新兴思想中的作用。