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  • 5-ALA Fluorescence guide removal in high grade glioma: technical observations

    Final Number:

    Piero Andrea Oppido MD PhD; Carmine Carapella; Alfredo Pompili; Antonello Vidiri MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: The treatment of malignant glioma is complete as possible resection of the contrast-enhancing tumor tissue, followed by adjuvant treatment with radiotherapy and chemotherapy.Recently, fluorescence guidance by 5-aminolevulinic acid (5-ALA)during surgical removal of malignant glioma is posssible.

    Methods: 54 patients were operated on using fluorescence guided tumor resection. Preoperatively, all enrolled patients had MRI showing contrast enhancing lesions. MRI within 72 hours after surgery and thereafter at 3-month interval was performed. 32 patients were newly diagnosed tumour, 22 were recurrent malignant glioma. An oral dose of 20 mg 5-ALA /kg body weight was administered to each patient. By 5-ALA fluorescence, the surgical resection was performed. Histology was in 48 glioblastoma (1 gliosarcoma), in 4 anaplastic oligodendroglioma, in 1 oligodendroglioma I WHO and in 1 pleomorphic xanthoastrocytoma. All the patients, as first line treatment, were submitted to radiotherapy and chemotherapy; in recurrent tumors second and in some cases third line treatments were administered. The follow-up ranged from 3 years to 8 months.

    Results: In 47 glioblastoma, 4 anaplastic oligodendroglioma and 1 xanthoastrocytoma the tumor tissue showed intraoperative red fluorescence by 5-ALA. Specially in recurrent tumors, the fluorescence-guided surgery was helpful to identify, inside the gliotic tissue, some areas with active tumor from perilesional “healthy” brain. Furthermore, after surgery no relevant neurological deficit caused by 5-ALA guided resection were observed. Early postoperative MRI confirmed gross total resection without contrast enhancment in 80 % of patients. At the follow-up 24 patients are still alive.

    Conclusions: The 5-ALA was helpful to localize the tumor on the cortex and extended resection of infiltrating tumour, specially in recurrence. Patients affected by glioblastoma are elctive for this technique. Extended resections by 5-ALA fluorescence guide does not impair neurological functions and can impact on the overall survival of patients affected by malignant glioma.

    Patient Care: this paper is to report the efficacy of fluorescence guide resection can improve survival in glioma population

    Learning Objectives: 1)importance of the fluorescence guide surgery 2)discuss on the efficacy of the 5-ALA for tumor infiltrating tissue 3) identfy the criticism of 5-ALA surgery


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