title: Fluorescence-guided surgery and biopsy in gliomas with an exoscope system.
abstract: BACKGROUND
  The introduction of fluorescence-guided resection allows a better identification of tumor tissue and its more radical resection. We describe our experience with a modified exoscope to detect 5 ALA-induced fluorescence in neuronavigation-guided brain surgery or biopsy of malignant brain tumors.
  
  
  METHODS
  Thirty-eight patients with a suspected preoperative diagnosis of high-grade astrocytoma were included. We used a neuronavigation device and a high-definition exoscope system with a built-in filter to detect 5-ALA fluorescence in all cases. Thirty patients underwent craniotomy with tumor resection and 8 underwent frameless stereotactic brain biopsy.
  
  
  RESULTS
  Histopathological diagnosis confirmed the presence of high-grade gliomas in 34 patients. Total resection was achieved in 23 cases and subtotal in 7. No relevant complications related to the administration of 5-ALA were detected.
  
  
  CONCLUSIONS
  The use of the exoscope in 5-ALA fluorescence-guided tumor surgery has twofold implications: during brain tumor surgery it can be considered a valuable tool to achieve a more radical resection of the lesion, and when applied to a biopsy of a suspected brain high-grade glioma, it decreases the possibility of a negative biopsy.
authors: Department of Neurosurgery, Hospital de la Ribera, Carretera Corbera km1, 46600 Alzira, Valencia, Spain.
authors: José
authors: J
authors: Piquer
authors: Department of Neurosurgery, Hospital de la Ribera, Carretera Corbera km1, 46600 Alzira, Valencia, Spain.
authors: Jose L
authors: JL
authors: Llácer
authors: Department of Neurosurgery, Hospital de la Ribera, Carretera Corbera km1, 46600 Alzira, Valencia, Spain.
authors: Vicente
authors: V
authors: Rovira
authors: Department of Neurosurgery, Hospital de la Ribera, Carretera Corbera km1, 46600 Alzira, Valencia, Spain.
authors: Pedro
authors: P
authors: Riesgo
authors: Department of Neurosurgery, Hospital de la Ribera, Carretera Corbera km1, 46600 Alzira, Valencia, Spain.
authors: Ruben
authors: R
authors: Rodriguez
authors: Department of Pathology, Hospital de la Ribera, Alzira, Spain.
authors: Antonio
authors: A
authors: Cremades
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000737:chemistry*; D001254:Astrocytoma / Q000601:surgery*; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D005453:Fluorescence; D005910:Glioma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D055815:Young Adult
chemical_list: D000622:Aminolevulinic Acid