title: Use of 5-ALA fluorescence guided endoscopic biopsy of a deep-seated primary malignant brain tumor.
abstract: The introduction of fluorescence-guided resection of primary malignant brain tumors was a milestone in neurosurgery. Deep-seated malignant brain tumors are often not approachable for microsurgical resection. For diagnosis and therapy, new strategies are recommended. The combination of endoscopy and 5-aminolevulinic acid-induced protoporphyrin IX (5-ALA-induced Pp IX) fluorescence-guided procedures supported by neuronavigation seems an interesting option. Here the authors report on a combined approach for 5-ALA fluorescence-guided biopsy in which they use an endoscopy system based on an Xe lamp (excitation approximately λ = 407 nm; dichroic filter system λ = 380-430 nm) to treat a malignant tumor of the thalamus and perform a ventriculostomy and septostomy. The excitation filter and emission filter are adapted to ensure that the remaining visible blue remission is sufficient to superimpose on or suppress the excited red fluorescence of the endogenous fluorochromes. The authors report that the lesion was easily detectable in the fluorescence mode and that biopsy led to histological diagnosis.
authors.affiliation: Department of Neurosurgery, University of Tübingen Medical Center, Tübingen, Germany. rainer_ritz@hotmail.com
authors.forename: Rainer
authors.initials: R
authors.lastname: Ritz
authors.forename: Guenther C
authors.initials: GC
authors.lastname: Feigl
authors.forename: Martin U
authors.initials: MU
authors.lastname: Schuhmann
authors.forename: André
authors.initials: A
authors.lastname: Ehrhardt
authors.forename: Soeren
authors.initials: S
authors.lastname: Danz
authors.forename: Susan
authors.initials: S
authors.lastname: Noell
authors.forename: Antje
authors.initials: A
authors.lastname: Bornemann
authors.forename: Marcos S
authors.initials: MS
authors.lastname: Tatagiba
mesh_terms: D000328:Adult; D000622:Aminolevulinic Acid; D001706:Biopsy / Q000295:instrumentation*; D001932:Brain Neoplasms / Q000473:pathology*; D002421:Caudate Nucleus / Q000473:pathology; D004724:Endoscopy / Q000295:instrumentation*; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008856:Microscopy, Fluorescence / Q000295:instrumentation*; D008866:Microsurgery / Q000295:instrumentation*; D038361:Neuronavigation / Q000295:instrumentation*; D009837:Oligodendroglioma / Q000473:pathology*; D017319:Photosensitizing Agents; D013786:Thalamic Diseases / Q000473:pathology*; D020542:Third Ventricle / Q000473:pathology; D014696:Ventriculostomy / Q000295:instrumentation
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid