title: Surgery guided by 5-aminolevulinic fluorescence in glioblastoma: volumetric analysis of extent of resection in single-center experience.
abstract: We analyzed the efficacy and applicability of surgery guided by 5-aminolevulinic acid (ALA) fluorescence in consecutive patients with glioblastoma multiforme (GBM). Thirty-six patients with GBM were operated on using ALA fluorescence. Resections were performed using the fluorescent light to assess the right plane of dissection. In each case, biopsies with different fluorescent quality were taken from the tumor center, from the edges, and from the surrounding tissue. These samples were analyzed separately with hematoxylin-eosin examination and immunostaining against Ki67. Tumor volume was quantified with pre- and postoperative volumetric magnetic resonance imaging. Strong fluorescence identified solid tumor with 100% positive predictive value. Invaded tissue beyond the solid tumor mass was identified by vague fluorescence with 97% positive predictive value and 66% negative predictive value, measured against hematoxylin-eosin examination. All the contrast-enhancing volume was resected in 83.3% of the patients, all patients had resection over 98% of the volume and mean volume resected was 99.8%. One month after surgery there was no mortality, and new or increased neurological morbidity was 8.2%. The fluorescence induced by 5-aminolevulinic can help to achieve near total resection of enhancing tumor volume in most surgical cases of GBM. It is possible during surgery to obtain separate samples of the infiltrating cells from the tumor border.
authors.affiliation: Departamento de Neurocirugía, Clinica Universitaria de Navarra, Avda Pio XII, 36, 31008 Pamplona, Navarra, Spain. rdiezvalle@unav.es
authors.forename: Ricardo
authors.initials: R
authors.lastname: Díez Valle
authors.forename: Sonia
authors.initials: S
authors.lastname: Tejada Solis
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Idoate Gastearena
authors.forename: Reyes
authors.initials: R
authors.lastname: García de Eulate
authors.forename: Pablo
authors.initials: P
authors.lastname: Domínguez Echávarri
authors.forename: Javier
authors.initials: J
authors.lastname: Aristu Mendiroz
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005453:Fluorescence; D005909:Glioblastoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007124:Immunoenzyme Techniques; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D017319:Photosensitizing Agents; D011379:Prognosis; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid