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Review
. 2019 Feb;141(3):517-522.
doi: 10.1007/s11060-018-2956-8. Epub 2018 Aug 10.

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

Muhammad Omar Chohan  1 , Mitchel S Berger  2
Affiliations
Review

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

Muhammad Omar Chohan et al. J Neurooncol. 2019 Feb.

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.

Keywords: Five-aminolevulinic acid (5-ALA); Fluorescence guided surgery (FGS); Neurosurgery; Recurrent anaplastic astrocytoma; Recurrent glioblastoma; Recurrent high grade glioma.

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