5-Aminolevulinic Acid-Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review.
The current first-line treatment of malignant gliomas consists in surgical resection (if possible) as large as possible. The existing tools don't permit to identify the limits of tumor infiltration, which goes beyond the zone of contrast enhancement on MRI. The fluorescence-guided malignant gliomas surgery was started 15 years ago and had become a standard of care in many countries. The technique is based on fluorescent molecule revelation using the filters, positioned within the surgical microscope. The fluorophore, protoporphyrin IX (PpIX), is converted in tumoral cells from 5-aminolevulinic acid (5-ALA), given orally before surgery. Many studies have shown that the ratio of gross total resections was higher if the fluorescence technique was used. The fluorescence signal intensity is correlated to the cell density and the PpIX concentration. The current method has a very high specificity but still lower sensibility, particularly regarding the zones with poor tumoral infiltration. This book reviews the principles of the technique and the results (extent of resection and survival).
Department of Neurosurgery, Neurological Hospital, Lyon, France. jacques.guyotat@chu-lyon.fr.
Jacques
J
Guyotat
Department of Neurosurgery, Sainte Anne Hospital, Paris, France. johanpallud@hotmail.com.|Paris Descartes University, Paris, France. johanpallud@hotmail.com.
Johan
J
Pallud
Délégation à la recherche clinique et à l'innovation, cellule innovation Hospices Civils de, Lyon, France. xavier.armoiry@chu-lyon.fr.
Xavier
X
Armoiry
Department of Neurosurgery, Neurological Hospital, Lyon, France. vladislav.pavlov@neurochirurgie.fr.
Vladislav
V
Pavlov
Department of Neurosurgery, Timone Hospital, Marseille, France. philippe.metellus@ap-hm.fr.|University Aix Marseille, Marseille, France. philippe.metellus@ap-hm.fr.
Philippe
P
Metellus
D000622:Aminolevulinic Acid; D001921:Brain / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D005453:Fluorescence; D005909:Glioblastoma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008856:Microscopy, Fluorescence / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D060787:Neoplasm Grading; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D038361:Neuronavigation / Q000379:methods*; D011524:Protoporphyrins / Q000378:metabolism*; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D025321:Surgery, Computer-Assisted / Q000379:methods*
D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX
5-Aminolevulinic acid; Fluorescence; High-grade glioma; Review; Surgery