Fluorescence-guided resection of metastatic brain tumors using a 5-aminolevulinic acid-induced protoporphyrin IX: pathological study.
We performed a pathological study to identify the locus of production of protoporphyrin IX (PPIX) in human metastatic brain tumors. Patients with metastatic brain tumors (n = 11) received 1 g of 5-aminolevulinic acid (5-ALA) perorally 2 h before undergoing surgery. The target region was exposed to laser light with a peak wavelength of 405 +/- 1 nm and an output of 40 mW. Tissue samples from the tumor bulk and surrounding areas were examined by histological and fluorescence methods. Of the 11 tumors, 9 manifested PPIX fluorescence in the tumor bulk and peritumoral brain tissue. Our findings indicate that PPIX fluorescence can be observed in peritumoral edematous areas that are free of neoplastic cells, because PPIX produced by neoplastic cells leaks into the surrounding edematous area.
Utsuki
Satoshi
S
Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan. utsuki@med.kitasato-u.ac.jp
Miyoshi
Norio
N
Oka
Hidehiro
H
Miyajima
Yoshiteru
Y
Shimizu
Satoru
S
Suzuki
Sachio
S
Fujii
Kiyotaka
K
D000622:Aminolevulinic Acid / Q000378:metabolism; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D008856:Microscopy, Fluorescence; D019635:Neurosurgical Procedures / Q000379:methods*; D017319:Photosensitizing Agents; D011524:Protoporphyrins
D017319:Photosensitizing Agents; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX