title: Role of neurochemical navigation with 5-aminolevulinic acid during intraoperative MRI-guided resection of intracranial malignant gliomas.
abstract: OBJECTIVE
  To evaluate the role of the neurochemical navigation with 5-aminolevulinic acid (5-ALA) during intraoperative MRI (iMRI)-guided resection of the intracranial malignant gliomas.
  
  
  METHODS
  The analysis included 99 consecutive surgical cases. Resection of the bulk of the neoplasm was mainly guided by the updated neuronavigation based on the low-field-strength (0.3T) iMRI, whereas at the periphery of the lesion neurochemical navigation with 5-ALA was additionally used.
  
  
  RESULTS
  In total, 286 tissue specimens were obtained during surgeries for histopathological examination. According to iMRI 98 samples with strong (91 cases), weak (6 cases), or absent (1 case) fluorescence corresponded to the bulk of the lesion and all of those ones contained tumor. Out of 188 tissue specimens obtained from the "peritumoral brain," the neoplastic elements were identified in 89%, 81% and 29% of samples with, respectively, strong (107 cases), weak (47 cases) and absent (34 cases) fluorescence. Positive predictive values of the tissue fluorescence for presence of neoplasm within and outside of its boundaries on iMRI were 100% and 86%, respectively.
  
  
  CONCLUSIONS
  Neurochemical navigation with 5-ALA is useful adjunct during iMRI-guided resection of intracranial malignant gliomas, which allows identification of the tumor extension beyond its radiological borders.
authors.affiliation: Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Departments of Business Development and Research and Development, Nobelpharma Co., Ltd., Tokyo, Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: ymuragaki@twmu.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Muragaki
authors.affiliation: Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan; Laboratory of Brain Tumor Pathology, Department of Brain Development and Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Komori
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005456:Fluorescent Dyes; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D019635:Neurosurgical Procedures / Q000379:methods; D055815:Young Adult
chemical_list: D005456:Fluorescent Dyes; D000622:Aminolevulinic Acid
keywords: 5-ALA; Intraoperative MRI; Malignant glioma; Neurochemical navigation; Photodynamic diagnosis; Surgical resection