title: The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors.
abstract: BACKGROUND
  Whereas in the adult population 5-Aminolevulinic acid (5-ALA) fluorescence guidance has been widely accepted for improving the extent of tumor resection, the application in children remains an off-label use. Even though most pediatric study protocols require a complete resection for improving outcome parameters, only few pediatric patients have been operated with fluorescence guidance, and it remains questionable, whether and which pediatric tumors show useful fluorescence. We present casuistic reports of application of 5-ALA in children collected from three different neurosurgical departments.
  
  
  METHODS
  In children with suspected malignant intracerebral tumor or recurrence, individual informed consent was obtained in each case from the parents. 5-ALA was administered according to the adult protocol, with 20 mg/kg, 2 h before induction of anesthesia. We retrospectively analyzed 18 patients (13 male, 5 female; age 3-18 years), using the intraoperative neurosurgical protocol, the postoperative MRI results, and the follow-up clinical examinations.
  
  
  RESULTS
  The use of 5-ALA fluorescence guidance proved to be safe in our group of pediatric patients. Fluorescence guidance was most useful for recurrent glioblastoma resection. Medulloblastoma tissue displayed fluorescence only inconsistently, and most pilocytic astrocytoma remained without staining. Ganglioglioma showed partial staining in the central tumor areas, without allowing the use for circumferent resection.
  
  
  CONCLUSIONS
  The off-label use of 5-ALA fluorescence guidance in pediatric patients appears to be most useful in recurrent high-grade gliomas. Fluorescence accumulation in other pediatric brain tumor entities is not predictable and should be evaluated in future clinical studies before being integrated into the current treatment protocols.
authors.affiliation: Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany. preuss@neurosurgeon.ch
authors.forename: M
authors.initials: M
authors.lastname: Preuß
authors.forename: C
authors.initials: C
authors.lastname: Renner
authors.forename: W
authors.initials: W
authors.lastname: Krupp
authors.forename: H
authors.initials: H
authors.lastname: Christiansen
authors.forename: L
authors.initials: L
authors.lastname: Fischer
authors.forename: A
authors.initials: A
authors.lastname: Merkenschlager
authors.forename: W
authors.initials: W
authors.lastname: Kieß
authors.forename: W
authors.initials: W
authors.lastname: Müller
authors.forename: N
authors.initials: N
authors.lastname: Manzo
authors.forename: J
authors.initials: J
authors.lastname: Meixensberger
authors.forename: U
authors.initials: U
authors.lastname: Nestler
mesh_terms: D000293:Adolescent; D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017319:Photosensitizing Agents; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid