Fluorescent Dyes in Modern Neurosurgery: Technological Advances and Clinical Translation

Introduction and purpose: Over recent decades, neurosurgery has undergone major technological advancement toward increased precision and safety, including the development of fluorescence-guided surgery. Conventional white-light microscopy has limited ability to distinguish pathological from normal tissue or to assess vascular flow in real time. Fluorescent dyes enhance intraoperative visualization and support surgical decision-making. This review aims to summarize the properties, mechanisms of action, clinical applications, and safety profiles of fluorescent dyes used in contemporary neurosurgery. Materials and methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar (2000–2025) using keywords including fluorescence-guided surgery, fluorescent dyes, neurosurgery, 5-aminolevulinic acid, fluorescein, indocyanine green, ICG angiography, glioma surgery, brain tumor resection, aneurysm clipping, vascular neurosurgery, near-infrared imaging, intraoperative imaging, and optical navigation. Eligible studies were qualitatively analyzed and synthesized narratively. Conclusion: Fluorescent dyes have become integral tools in modern neurosurgery, enhancing visualization of tumors and vascular structures beyond conventional white-light microscopy. 5-ALA, fluorescein, and indocyanine green each provide unique mechanisms of fluorescence, supporting tailored intraoperative decision-making. Overall, these agents are well-tolerated, with severe adverse events being rare. Future advancements are likely to focus on integrating fluorescence with machine learning, augmented reality, quantitative assessment, and novel imaging technologies, improving precision and objectivity. While their current clinical position is stable, ongoing technological evolution may expand applications and refine existing techniques, maintaining fluorescence-guided surgery as a cornerstone of precision neurosurgical practice.