title: Impact of the combination of 5-aminolevulinic acid-induced fluorescence with intraoperative magnetic resonance imaging-guided surgery for glioma.
abstract: OBJECTIVE
  To compare intraoperative magnetic resonance imaging (MRI)-guided resection with resection guided by 5-aminolevulinic acid (5-ALA)-induced fluorescence in patients with gliomas and to evaluate the impact of intraoperative MRI in glioma surgery.
  
  
  METHODS
  From January 2005 to February 2009, 33 patients with gliomas (6 with World Health Organization [WHO] grade II, 7 with WHO grade III, 20 with WHO grade IV) who underwent craniotomy with neuronavigation and received 5-ALA by the same neurosurgeon were investigated retrospectively. In 19 patients, operations were performed using a combination of 5-ALA with intraoperative 1.5-T MRI. All patients were subjected to postoperative 1.5-T MRI to confirm the extent of resection.
  
  
  RESULTS
  Of 33 patients with gliomas, 21 (4 with WHO grade III and 17 with WHO grade IV) were 5-ALA-induced fluorescence-positive (5-ALA (+)). Surgery with intraoperative MRI was performed in 10 of the 21 patients, and the average resection rate was 92.6%. The average resection rate of patients who underwent surgery without intraoperative MRI was 91.8%. 5-ALA-induced fluorescence was not detected in 12 patients (6 with WHO grade II, 3 with WHO grade III, and 3 with WHO grade IV) with gliomas. Surgery with intraoperative MRI was performed in 9 of 12 patients, and the average resection rate was 89.2%. The average resection rate of patients who underwent surgery without intraoperative MRI was 68.7%. Intraoperative MRI-guided tumor resection resulted in a better resection rate in patients with 5-ALA-induced fluorescence-negative (5-ALA (-)) gliomas than in patients with 5-ALA (+) gliomas (20.5% vs 0.8%).
  
  
  CONCLUSIONS
  Intraoperative MRI-guided resection is a powerful tool to treat 5-ALA (-) gliomas (mostly low grade), and 5-ALA is useful for high-grade gliomas. The combination of intraoperative MRI and 5-ALA has a synergistic effect in glioma surgery. Additionally, precise tumor grading in preoperative imaging studies can be difficult. Surgery for gliomas should be performed using both 5-ALA-induced fluorescence and intraoperative MRI-guided resection.
authors.affiliation: Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan. tsugu@is.icc.u-tokai.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tsugu
authors.forename: Hideo
authors.initials: H
authors.lastname: Ishizaka
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Mizokami
authors.forename: Takahiro
authors.initials: T
authors.lastname: Osada
authors.forename: Tanefumi
authors.initials: T
authors.lastname: Baba
authors.forename: Michitsura
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Jun
authors.initials: J
authors.lastname: Nishiyama
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsumae
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005453:Fluorescence; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D019635:Neurosurgical Procedures / Q000379:methods*; D017319:Photosensitizing Agents; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid