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

Al's Comment:

 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.
2. Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave. Rm. M779, San Francisco, CA, 94143-0112, USA.
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.
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.
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.
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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