title: Predicting the "usefulness" of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey.
abstract: BACKGROUND
  Five-aminolevulinic acid (Gliolan, medac, Wedel, Germany, 5-ALA) is approved for fluorescence-guided resections of adult malignant gliomas. Case reports indicate that 5-ALA can be used for children, yet no prospective study has been conducted as of yet. As a basis for a study, we conducted a survey among certified European Gliolan users to collect data on their experiences with children.
  
  
  METHODS
  Information on patient characteristics, MRI characteristics of tumors, histology, fluorescence qualities, and outcomes were requested. Surgeons were further asked to indicate whether fluorescence was "useful", i.e., leading to changes in surgical strategy or identification of residual tumor. Recursive partitioning analysis (RPA) was used for defining cohorts with high or low likelihoods for useful fluorescence.
  
  
  RESULTS
  Data on 78 patients <18 years of age were submitted by 20 centers. Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III (80 %). Fluorescence was found inconsistently useful in PNETs (three of seven; 43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) and pilocytic astrocytomas (two of 13; 15 %). RPA of pre-operative factors showed tumors with supratentorial location, strong contrast enhancement and first operation to have a likelihood of useful fluorescence of 64.3 %, as opposed to infratentorial tumors with first surgery (23.1 %).
  
  
  CONCLUSIONS
  Our survey demonstrates 5-ALA as being used in pediatric brain tumors. 5-ALA may be especially useful for contrast-enhancing supratentorial tumors. These data indicate controlled studies to be necessary and also provide a basis for planning such a study.
authors.affiliation: Department of Neurosurgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany, walter.stummer@ukmuenster.de.
authors.forename: Walter
authors.initials: W
authors.lastname: Stummer
authors.forename: Floriano
authors.initials: F
authors.lastname: Rodrigues
authors.forename: Philippe
authors.initials: P
authors.lastname: Schucht
authors.forename: Matthias
authors.initials: M
authors.lastname: Preuss
authors.forename: Dorothee
authors.initials: D
authors.lastname: Wiewrodt
authors.forename: Ulf
authors.initials: U
authors.lastname: Nestler
authors.forename: Marco
authors.initials: M
authors.lastname: Stein
authors.forename: José Manuel Cabezudo
authors.initials: JM
authors.lastname: Artero
authors.forename: Nunzio
authors.initials: N
authors.lastname: Platania
authors.forename: Jane
authors.initials: J
authors.lastname: Skjøth-Rasmussen
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.forename: John
authors.initials: J
authors.lastname: Caird
authors.forename: Søren
authors.initials: S
authors.lastname: Cortnum
authors.forename: Sam
authors.initials: S
authors.lastname: Eljamel
authors.forename: Christian
authors.initials: C
authors.lastname: Ewald
authors.forename: Laura
authors.initials: L
authors.lastname: González-García
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Martin
authors.forename: Ante
authors.initials: A
authors.lastname: Melada
authors.forename: Aurelia
authors.initials: A
authors.lastname: Peraud
authors.forename: Angela
authors.initials: A
authors.lastname: Brentrup
authors.forename: Thomas
authors.initials: T
authors.lastname: Santarius
authors.forename: Hans Herbert
authors.initials: HH
authors.lastname: Steiner
mesh_terms: D000293:Adolescent; D000622:Aminolevulinic Acid / Q000032:analysis*; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003625:Data Collection; D005060:Europe; D005260:Female; D005453:Fluorescence; D005910:Glioma / Q000601:surgery*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D061848:Optical Imaging / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D000622:Aminolevulinic Acid