title: A surgical loupe system for observing protoporphyrin IX fluorescence in high-grade gliomas after administering 5-aminolevulinic acid.
abstract: BACKGROUND
  We recently developed a surgical loupe system for observing the fluorescence emitted by protoporphyrin IX (PpIX), a metabolite of 5-aminolevulinic acid.
  
  
  METHODS
  This system used a semiconductor laser as the excitation light source. A compact, transparent, and ultraviolet cut-off filter was mounted on an eyepiece lens, which did not require filter on-off manipulation.
  
  
  RESULTS
  Good quality protoporphyrin IX fluorescence was acquired using the surgical loupe system during glioblastoma resection, which was nearly identical to that acquired by fluorescent microscopy. In addition, surgeons can perform ordinary surgical procedures using this surgical loupe system under white light.
  
  
  CONCLUSIONS
  This surgical loupe system enables the detection of PpIX fluorescence during resection of high-grade glioma. Further evaluations of this system are required to determine the extent of surgical resection before its practical application.
authors.affiliation: Department of Neurosurgery, Osaka Medical College, Japan. Electronic address: neu040@poh.osaka-med.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kuroiwa
authors.forename: Yoshinaga
authors.initials: Y
authors.lastname: Kajimoto
authors.forename: Motomasa
authors.initials: M
authors.lastname: Furuse
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Miyatake
mesh_terms: D021542:Amino Acids, Neutral / Q000032:analysis*; D001932:Brain Neoplasms / Q000737:chemistry* / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005139:Eyeglasses; D005453:Fluorescence; D005909:Glioblastoma / Q000737:chemistry* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation; D008866:Microsurgery / Q000295:instrumentation; D060787:Neoplasm Grading; D011524:Protoporphyrins / Q000032:analysis*; D011838:Radiation-Sensitizing Agents / Q000032:analysis; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D021542:Amino Acids, Neutral; D011524:Protoporphyrins; D011838:Radiation-Sensitizing Agents; C013809:5-aminovaleric acid; C028025:protoporphyrin IX
keywords: 5-Aminolevulinic acid; Glioma; Surgery; Surgical loupes