title: 5-Aminolevulinic acid fluorescence in high grade glioma surgery: surgical outcome, intraoperative findings, and fluorescence patterns.
abstract: BACKGROUND
  5-Aminolevulinic acid (5-ALA) fluorescence is a validated technique for resection of high grade gliomas (HGG); the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients.
  
  
  METHODS
  Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection (GTR) > 98% and GTR > 90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO).
  
  
  RESULTS
  94 patients were finally enrolled. Overall GTR > 98% and GTR > 90% was achieved in 93% and 100% of patients. Extent of resection (GTR > 98%) was dependent on tumor location, tumor grade (P < 0.05), and tumor size (P < 0.05). In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57%) (P < 0.01) and recurrent (60%) tumors.
  
  
  CONCLUSIONS
  5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ciccarino
authors.affiliation: Department of Oncology, IOV IRCCS Oncology Institute of Padua, Via Gattamelata 64, 35128 Padova, Italy.
authors.forename: Giuseppe
authors.identifier: 0000-0003-1316-2132
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: Neuroradiology Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128 Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rolma
authors.affiliation: Department of Medicine (DIMED), Nuclear Medicine Service, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Diego
authors.identifier: 0000-0001-7956-1924
authors.initials: D
authors.lastname: Cecchin
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Rossetto
mesh_terms: D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005453:Fluorescence; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid