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- Title
5-Aminolevulinic acid fluorescence guided surgery for recurrent high-grade gliomas.
- Authors
Chohan, Muhammad Omar; Berger, Mitchel S.
- Abstract
Introduction: Fluorescence guided surgery (FGS) with five-aminolevulinic acid (5-ALA) is expected to revolutionize neurosurgical care of patients with high-grade gliomas (HGG). After the recent landmark FDA approval, this optical agent is now available to neurosurgeons in the United States.Methods: This review is designed to highlight the evidence for the use of 5-ALA in recurrent HGG surgery for the neurosurgical community. The manuscript was prepared in accordance with the PRISMA guidelines.Results: Intra-operatively, a strong fluorescent signal is highly correlated with the presence of cellular tumor in recurrent HGG, giving it a high positive predictive value (PPV). Similar to what is observed in primary HGG surgery, false-negative results can occur if tumor cells do not emit fluorescence. In addition, false-positive fluorescence signals in tissues devoid of tumor cells can be observed more frequently in recurrent HGG compared to the primary setting. However, these areas overwhelmingly contain reactive/regressive tissue, resection of which is unlikely to cause functional deficits. The safety profile of 5-ALA is similarly favorable in primary and recurrent HGG.Conclusions: 5-ALA FGS is a powerful adjunct in the resection of recurrent HGG with a high PPV and favorable safety profile. It is therefore the authors' opinion to routinely employ this fluorescent agent as a standard of care.
- Subjects
UNITED States; GLIOMAS; SURGERY; NEUROSURGEONS; FLUORESCENCE; TUMORS
- Publication
Journal of Neuro-Oncology, 2019, Vol 141, Issue 3, p517
- ISSN
0167-594X
- Publication type
Article
- DOI
10.1007/s11060-018-2956-8