J Neurol Surg A Cent Eur Neurosurg 2012; 73 - P027
DOI: 10.1055/s-0032-1316229

Fluorescence-Guided Resection of Non-Astrocytic Tumors with 5-Aminolevulenic Acid

E. Albanese 1, H. Hasegawa 1, P.I. D’Urso 1, T. Jones 1, R. W. Gullan 1, K. Ashkan 1, R. S. Bhangoo 1
  • 1Department of Neurosurgery, King’s College Hospital, London, United Kingdom

Background: Fluorescence-guided surgery using 5-aminolevulenic acid (5-ALA) has been demonstrated to improve extent of resection and progression-free survival in high grade gliomas. Limited data exist about its use during surgical removal of nonglial tumors.

Aim: We report our experience in using 5-ALA for the removal of nonglial tumors.

Methods: A retrospective review of patients who underwent Gliolan®-guided resection of intra-axial tumors from April 2010 to March 2012 at a single institution was performed. 5-ALA (Gliolan) was used in patients with established or radiologically suspected high grade glioma in whom maximal debulking was planned. Gliolan was administered orally (20 mg/kg body weight). Surgery was performed with image guidance and a modified microscope (Pentero®, Carl Zeiss) equipped with a fluorescence kit including a violet-blue excitation. Histological reports were used to identify all cases of nonglial tumors. Operative reports and, when available, intraoperative imaging were reviewed to evaluate lesions which fluoresced.

Results: Total of 74 patients underwent 5-ALA-guided resection of intracranial tumors. Of these, 68 patients with glioblastoma and high grade glioma were excluded. The remaining six were included in the present study. The histological examination was consistent with anaplastic ependymoma in two patients, atypical meningioma in one patient, T-cell lymphoma in one patient, metastasis in one patient, and reactive changes in the remaining patient. The cases of anaplastic ependymomas, atypical meningioma, and T-cell lymphoma fluoresced intraoperatively.

Conclusions: Our study shows that 5-ALA can be useful during the removal of nonglial tumors, improving the control of the tumor resection. Although our results are encouraging, larger scale studies are necessary to accelerate efforts to validate our findings.

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