Outcomes after Combined Use of Intraoperative MRI and 5-Aminolevulinic Acid in High-Grade Glioma Surgery

Abstract BACKGROUND 5-ALA is known as useful tool for high grade glioma resection and the accumulation extent of 5-ALA is known as far beyond gadolinium enhancement. Extent of resection is key factor for favorable outcome and long-term survival for high grade glioma patients and 5-ALA might increase extent of resection. We present our experience of 5-ALA guided glioma surgeries METHODS Total 19 patients were performed 5-ALA guided surgery. They ingested 20mg/kg, four hours before craniotomy. We tried to perform supra-total resection rather than gross total resection according to the tumor consistency and if the tumor located relatively non-eloquent area, we tried to perform lobectomy rather than lesionectomy. After tumor resection, we inspect the tumor bed under 5-ALA fluorescence, and we confirmed the complete loss of fluorescence on the tumor resected bed. We check the MRI within 48 hour after operation and assess the extent of resection RESULTS Among the 19 patients, 15 patients were confirmed glioblastoma and 3 anaplastic astrocytoma and 1 anaplastic oligoastrocytoma. We confirmed all enhancing lesion was completely removed, however, 2 patients show residual non-enhancing lesion in post-operative MRI. Two patients suffered temporary hemiparesis and 2 patients show permanent visual field defect. CONCLUSION 5-ALA is useful tool for glioma surgery. Resection extent could be increased, however, non-enhancing lesion in the high grade gliomas, might be missed under 5-ALA guidance.

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5-Aminolevulinic Acid Fluorescence in High Grade Glioma Surgery: Surgical Outcome, Intraoperative Findings, and Fluorescence Patterns

BioMed Research International ◽

10.1155/2014/232561 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 18

Author(s):

Alessandro Della Puppa ◽

Pietro Ciccarino ◽

Giuseppe Lombardi ◽

Giuseppe Rolma ◽

Diego Cecchin ◽

...

Keyword(s):

Tumor Size ◽

Surgical Outcome ◽

Aminolevulinic Acid ◽

High Grade Glioma ◽

Tumor Grade ◽

Tumor Location ◽

Consecutive Series ◽

High Grade ◽

Glioma Surgery ◽

Surgical Data

Background. 5-Aminolevulinic acid (5-ALA) fluorescence is a validated technique for resection of high grade gliomas (HGG); the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients.Methods. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection(GTR)>98% andGTR>90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO).Results. 94 patients were finally enrolled. OverallGTR>98% andGTR>90% was achieved in 93% and 100% of patients. Extent of resection(GTR>98%)was dependent on tumor location, tumor grade(P<0.05), and tumor size(P<0.05). In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57%)(P<0.01)and recurrent (60%) tumors.Conclusions. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.

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Fluorescence-Guided High-Grade Glioma Surgery More Than Four Hours After 5-Aminolevulinic Acid Administration

Frontiers in Neurology ◽

10.3389/fneur.2021.644804 ◽

2021 ◽

Vol 12 ◽

Author(s):

Georgios A. Maragkos ◽

Alexander J. Schüpper ◽

Nikita Lakomkin ◽

Panagiotis Sideras ◽

Gabrielle Price ◽

...

Keyword(s):

Aminolevulinic Acid ◽

Peak Plasma ◽

Progression Free Survival ◽

High Grade Glioma ◽

Clinical Results ◽

Anesthesia Induction ◽

High Grade ◽

Karnofsky Score ◽

Glioma Surgery ◽

Intraoperative Fluorescence

Background: Fluorescence-guided surgery (FGS) using 5-aminolevulic acid (5-ALA) is a widely used strategy for delineating tumor tissue from surrounding brain intraoperatively during high-grade glioma (HGG) resection. 5-ALA reaches peak plasma levels ~4 h after oral administration and is currently approved by the FDA for use 2–4 h prior to induction to anesthesia.Objective: To demonstrate that there is adequate intraoperative fluorescence in cases undergoing surgery more than 4 h after 5-ALA administration and compare survival and radiological recurrence to previous data.Methods: Retrospective analysis of HGG patients undergoing FGS more than 4 h after 5-ALA administration was performed at two institutions. Clinical, operative, and radiographic pre- and post-operative characteristics are presented.Results: Sixteen patients were identified, 6 of them female (37.5%), with mean (SD) age of 59.3 ± 11.5 years. Preoperative mean modified Rankin score (mRS) was 2 ± 1. All patients were dosed with 20 mg/kg 5-ALA the morning of surgery. Mean time to anesthesia induction was 425 ± 334 min. All cases had adequate intraoperative fluorescence. Eloquent cortex was involved in 12 cases (75%), and 13 cases (81.3%) had residual contrast enhancement on postoperative MRI. Mean progression-free survival was 5 ± 3 months. In the study period, 6 patients died (37.5%), mean mRS was 2.3 ± 1.3, Karnofsky score 71.9 ± 22.1, and NIHSS 3.9 ± 2.4.Conclusion: Here we demonstrate that 5-ALA-guided HGG resection can be performed safely more than 4 h after administration, with clinical results largely similar to previous reports. Relaxation of timing restrictions could improve procedure workflow in busy neurosurgical centers, without additional risk to patients.

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5-aminolevulinic acid and neuronavigation in high-grade glioma surgery: results of a combined approach

Neurocirugía ◽

10.1016/j.neucir.2012.04.003 ◽

2012 ◽

Vol 23 (1) ◽

pp. 23-28 ◽

Cited By ~ 25

Author(s):

Pier Paolo Panciani ◽

Marco Fontanella ◽

Diego Garbossa ◽

Alessandro Agnoletti ◽

Alessandro Ducati ◽

...

Keyword(s):

Aminolevulinic Acid ◽

High Grade Glioma ◽

High Grade ◽

Combined Approach ◽

Glioma Surgery

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Characteristics of Fluorescent Intraoperative Dyes Helpful in Gross Total Resection of High-Grade Gliomas—A Systematic Review

Diagnostics ◽

10.3390/diagnostics10121100 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1100

Author(s):

Marek Mazurek ◽

Bartłomiej Kulesza ◽

Filip Stoma ◽

Jacek Osuchowski ◽

Sławomir Mańdziuk ◽

...

Keyword(s):

Indocyanine Green ◽

Aminolevulinic Acid ◽

High Grade Glioma ◽

Light Filter ◽

Gross Total Resection ◽

High Grade ◽

Total Resection ◽

Glioma Surgery ◽

Glioma Resection ◽

Intraoperative Fluorescence

Background: A very important aspect in the treatment of high-grade glioma is gross total resection to reduce the risk of tumor recurrence. One of the methods to facilitate this task is intraoperative fluorescence navigation. The aim of the study was to compare the dyes used in this technique fluorescent intraoperative navigation in terms of the mechanism of action and influence on the treatment of patients. Methods: The review was carried out on the basis of articles found in PubMed, Google Scholar, and BMC search engines, as well as those identified by searched bibliographies and suggested by experts during the preparation of the article. The database analysis was performed for the following phrases: “glioma”, “glioblastoma”, “ALA”, “5ALA”, “5-ALA”, “aminolevulinic acid”, ”levulinic acid”, “fluorescein”, “ICG”, “indocyanine green”, and “fluorescence navigation”. Results: After analyzing 913 citations identified on the basis of the search criteria, we included 36 studies in the review. On the basis of the analyzed articles, we found that 5-aminolevulinic acid and fluorescein are highly effective in improving the percentage of gross total resection achieved in high-grade glioma surgery. At the same time, the limitations resulting from the use of these methods are marked—higher costs of the procedure and the need to have neurosurgical microscope in combination with a special light filter in the case of 5-aminolevulinic acid (5-ALA), and low specificity for neoplastic cells and the dependence on the degree of damage to the blood–brain barrier in the intensity of fluorescence in the case of fluorescein. The use of indocyanine green in the visualization of glioma cells is relatively unknown, but some researchers have suggested its utility and the benefits of using it simultaneously with other dyes. Conclusion: The use of intraoperative fluorescence navigation with the use of 5-aminolevulinic acid and fluorescein allows the range of high-grade glioma resection to be increased.

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SURG-39. 5-AMINOLEVULINIC ACID FLUORESCENCE (5-ALA) GUIDED RESECTION OF GLIOBLASTOMA, LESSON LEARNED FROM 26 CASES

Neuro-Oncology ◽

10.1093/neuonc/noaa215.885 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii211-ii212

Author(s):

Jinmo Cho

Keyword(s):

Aminolevulinic Acid ◽

Tumor Resection ◽

High Grade Glioma ◽

Extent Of Resection ◽

High Grade ◽

Total Resection ◽

Glioma Surgery ◽

Term Survival ◽

Tumor Bed ◽

Key Factor

Abstract INTRODUCTION 5-ALA is known as useful tool for high grade glioma resection and the accumulation extent of 5-ALA is known as far beyond gadolinium enhancement. Extent of resection is key factor for favorable outcome and long-term survival for high grade glioma patients and 5-ALA might increase extent of resection. We present our experience of 5-ALA guided glioma surgeries. MATERIALS AND METHODS Total 26 patients were performed 5-ALA guided surgery. They ingested 20mg/kg, four hours before craniotomy. We tried to perform supra-total resection rather than gross total resection according to the tumor consistency and if the tumor located relatively non-eloquent area, we tried to perform lobectomy rather than lesionectomy. After tumor resection, we inspect the tumor bed under 5-ALA fluorescence, and we confirmed the complete loss of fluorescence on the tumor resected bed. We check the MRI within 48 hour after operation and assess the extent of resection. RESULTS Among the 26 patients, 22 patients were confirmed glioblastoma and 3 anaplastic astrocytoma and 1 anaplastic oligoastrocytoma. We confirmed all enhancing lesion was completely removed, however, 4 patients show residual non-enhancing lesion in post-operative MRI. Two patients suffered temporary hemiparesis and 2 patients show permanent visual field defect. CONCLUSION 5-ALA is useful tool for glioma surgery. Resection extent could be increased, however, non-enhancing lesion in the high grade gliomas, might be missed under 5-ALA guidance.

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