title: The use of 5-ALA to assist complete removal of residual non-enhancing part of childhood medulloblastoma: a case report.
abstract: OBJECTIVE
  Medulloblastoma is the most common malignant brain tumor in childhood. Radical surgery in the non-metastatic stage is an important factor with respect to overall survival. In this case, 5-aminolevulinic acid (5-ALA) was used at second-look surgery in order to improve surgical results.
  
  
  METHODS
  The child was pretreated with 3 × 4 mg dexamethasone for 4 days prior to the second surgery. At 5 a.m. on the day of surgery, a freshly prepared solution of 5-ALA (20 mg/kg body weight; Medac, Germany) was given orally.
  
  
  RESULTS
  At surgery, through the original opening, the vague red fluorescence of the tumor was clearly distinctive from the cerebellum with no tumor infiltration. All fluorescent tissue was removed. Postoperative MRI gave suspicion of yet at small tumor residue, but this structure is less than 1.5 ml in calculated volume, and consequently the recommended adjuvant therapy of the child changed from the high-risk medulloblastoma regimen to the standard-risk regimen.
  
  
  CONCLUSIONS
  In this particular difficult case of non-contrast-enhancing tumor, 5-ALA was of vital importance to improve rate of resection and change the aggressiveness needed in postsurgery radiation therapy.
authors.affiliation: Department of Neurosurgery, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark. jane@skjoeth-rasmussen.dk.
authors.forename: Jane
authors.identifier: http://orcid.org/0000-0001-8689-9704
authors.initials: J
authors.lastname: Skjøth-Rasmussen
authors.affiliation: Department of Neurosurgery, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Bøgeskov
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Astrid
authors.initials: A
authors.lastname: Sehested
authors.affiliation: Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Camilla
authors.initials: C
authors.lastname: Klausen
authors.affiliation: Department of Pathology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Broholm
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Karsten
authors.initials: K
authors.lastname: Nysom
mesh_terms: D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D017319:Photosensitizing Agents / Q000627:therapeutic use*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid
keywords: 5-ALA; Medulloblastoma; Pediatric; Radical surgery