title: 5-aminolevulinic acid (5-ALA) fluorescence guided surgery of high-grade gliomas in eloquent areas assisted by functional mapping. Our experience and review of the literature.
abstract: BACKGROUND
  Only few data are available on the specific topic of 5-aminolevulinic acid (5-ALA) guided surgery of high-grade gliomas (HGG) located in eloquent areas. Studies focusing specifically on the post-operative clinical outcome of such patients are yet not available, and it has not been so far explored whether such approach could be more suitable for some particular subgroups of patients.
  
  
  METHODS
  Patients affected by HGG in eloquent areas who underwent surgery assisted by 5-ALA fluorescence and intra-operative monitoring were prospectively recruited in our Department between June 2011 and August 2012. Resection rate was reported as complete resection of enhancing tumor (CRET), gross total resection (GTR) >98 % and GTR > 90 %. Clinical outcome was evaluated at 7, 30, and 90 days after surgery.
  
  
  RESULTS
  Thirty-one patients were enrolled. Resection was complete (CRET) in 74 % of patients. Tumor removal was stopped to avoid neurological impairment in 26 % of cases. GTR > 98 % and GTR > 90 % was achieved in 93 % and 100 % of cases, respectively. First surgery and awake surgery had a CRET rate of 80 % and 83 %, respectively. Even though at the first-week assessment 64 % of patients presented neurological impairment, there was a 3 % rate of severe morbidity at the 90th day assessment. Newly diagnosed patients had a significantly lower morbidity (0 %) and post-operative higher median KPS. Both pre-operative neurological condition and improvement after corticosteroids resulted significantly predictive of post-operative functional outcome.
  
  
  CONCLUSIONS
  5-ALA surgery assisted by functional mapping makes high HGG resection in eloquent areas feasible , through a reasonable rate of late morbidity. This emerges even more remarkably for selected patients.
authors.affiliation: Department of Neurosurgery, University Hospital of Padova, Via Giustiniani 2, Azienda Ospedaliera di Padova, 35128, Padova, Italy. alessandro.dellapuppa@sanita.padova.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.forename: Serena
authors.initials: S
authors.lastname: De Pellegrin
authors.forename: Elena
authors.initials: E
authors.lastname: d'Avella
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gioffrè
authors.forename: Marta
authors.initials: M
authors.lastname: Rossetto
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gerardi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lombardi
authors.forename: Renzo
authors.initials: R
authors.lastname: Manara
authors.forename: Marina
authors.initials: M
authors.lastname: Munari
authors.forename: Marina
authors.initials: M
authors.lastname: Saladini
authors.forename: Renato
authors.initials: R
authors.lastname: Scienza
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D005453:Fluorescence; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000622:Aminolevulinic Acid