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5-Aminolevulinic acid fluorescence guided surgery for recurrent high-grade gliomas.


Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)

 This is a dye used at the time of surgery to allow the surgeon to better setermine the difference between tumor and non tumor, allowing for a better chance at a total resection.   A total resectionn is associated with longer survival times.  It is now FDA approved and readily available!


Posted on: 08/16/2018

  J Neurooncol. 2018 Aug 10. doi: 10.1007/s11060-018-2956-8. [Epub ahead of print]
5-Aminolevulinic acid fluorescence guided surgery for recurrent high-grade gliomas.
Chohan MO1, Berger MS2.
 
Author information:
1. Department of Neurological Surgery, University of New Mexico, 2211 Lomas Blvd. NE, Albuquerque, NM, 87111, USA. mchohan@salud.unm.edu.
2. Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave. Rm. M779, San Francisco, CA, 94143-0112, USA.
Abstract
INTRODUCTION:
 
Fluorescence guided surgery (FGS) with five-aminolevulinic acid (5-ALA) is expected to revolutionize neurosurgical care of patients with high-grade gliomas (HGG). After the recent landmark FDA approval, this optical agent is now available to neurosurgeons in the United States.
METHODS:
 
This review is designed to highlight the evidence for the use of 5-ALA in recurrent HGG surgery for the neurosurgical community. The manuscript was prepared in accordance with the PRISMA guidelines.
RESULTS:
 
Intra-operatively, a strong fluorescent signal is highly correlated with the presence of cellular tumor in recurrent HGG, giving it a high positive predictive value (PPV). Similar to what is observed in primary HGG surgery, false-negative results can occur if tumor cells do not emit fluorescence. In addition, false-positive fluorescence signals in tissues devoid of tumor cells can be observed more frequently in recurrent HGG compared to the primary setting. However, these areas overwhelmingly contain reactive/regressive tissue, resection of which is unlikely to cause functional deficits. The safety profile of 5-ALA is similarly favorable in primary and recurrent HGG.
CONCLUSIONS:
 
5-ALA FGS is a powerful adjunct in the resection of recurrent HGG with a high PPV and favorable safety profile. It is therefore the authors' opinion to routinely employ this fluorescent agent as a standard of care.
PMID: 30097823 

 




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