5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience
Summary: Background: 5-Aminolevulinic Acid (5-ALA) induced fluorescence is useful in guiding glioma resection. The extent of 5-ALA accumulation is beyond gadolinium contrast enhancement.1,2 Supratotal resection may be achieved, potentially granting patients with better survival.We present our exper...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-09-01
|
| Series: | Asian Journal of Surgery |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958417302476 |
| _version_ | 1819142157048479744 |
|---|---|
| author | Danny Tat Ming Chan Hsieh Yi-Pin Sonia Wai Sang Poon |
| author_facet | Danny Tat Ming Chan Hsieh Yi-Pin Sonia Wai Sang Poon |
| author_sort | Danny Tat Ming Chan |
| collection | DOAJ |
| description | Summary: Background: 5-Aminolevulinic Acid (5-ALA) induced fluorescence is useful in guiding glioma resection. The extent of 5-ALA accumulation is beyond gadolinium contrast enhancement.1,2 Supratotal resection may be achieved, potentially granting patients with better survival.We present our experience on 5-ALA guided glioma resection in Chinese ethnics. Method: Sixteen Patients ingested 5-ALA (Gliolan, Medas Germany) 20 mg/kg·m2 4 h before surgery. The tumor resection was guided by fluorescence with neurosurgical microscope. Patient was monitored for general condition, especially for new neurological deficits. Postoperative MRI served as the assessment for extent of resection (EOR). Result: High grade glioma was confirmed in 12 cases, low grade glioma in three and one inflammation. 5-ALA was used in ten patients with known malignant glioma, and in six patients with presumed diagnosis of malignant glioma. Fifteen cases had positive fluorescence. The intensity was strong in eight and moderate in seven cases. MRI suggested total resection was achieved in 9 patients, near total resection in two and five had subtotal resection. EOR was associated with duration between ingestion of 5-ALA and timing when microscope was brought in for visualization of fluorescence (p = 0.038). Two patients suffered from temporary visual field defects. One patient developed hemiparesis after surgery. Conclusion: 5-ALA is a useful intra-operative guidance for resection. It increases the percentage of total removal of the tumor. It should be used within the window period of the action (4–12 h). Keywords: 5-Aminolevulinic acid, Malignant glioma, Fluorescence guided surgery, Protophophrin IX, Extent of resection |
| first_indexed | 2024-12-22T12:05:53Z |
| format | Article |
| id | doaj.art-e916752820df4f1e97d04baa33fa9a59 |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-12-22T12:05:53Z |
| publishDate | 2018-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-e916752820df4f1e97d04baa33fa9a592022-12-21T18:26:27ZengElsevierAsian Journal of Surgery1015-95842018-09-014154674725-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experienceDanny Tat Ming Chan0Hsieh Yi-Pin Sonia1Wai Sang Poon2Corresponding author. CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR. Fax: +86 852 26377974.; CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SARCUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SARCUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SARSummary: Background: 5-Aminolevulinic Acid (5-ALA) induced fluorescence is useful in guiding glioma resection. The extent of 5-ALA accumulation is beyond gadolinium contrast enhancement.1,2 Supratotal resection may be achieved, potentially granting patients with better survival.We present our experience on 5-ALA guided glioma resection in Chinese ethnics. Method: Sixteen Patients ingested 5-ALA (Gliolan, Medas Germany) 20 mg/kg·m2 4 h before surgery. The tumor resection was guided by fluorescence with neurosurgical microscope. Patient was monitored for general condition, especially for new neurological deficits. Postoperative MRI served as the assessment for extent of resection (EOR). Result: High grade glioma was confirmed in 12 cases, low grade glioma in three and one inflammation. 5-ALA was used in ten patients with known malignant glioma, and in six patients with presumed diagnosis of malignant glioma. Fifteen cases had positive fluorescence. The intensity was strong in eight and moderate in seven cases. MRI suggested total resection was achieved in 9 patients, near total resection in two and five had subtotal resection. EOR was associated with duration between ingestion of 5-ALA and timing when microscope was brought in for visualization of fluorescence (p = 0.038). Two patients suffered from temporary visual field defects. One patient developed hemiparesis after surgery. Conclusion: 5-ALA is a useful intra-operative guidance for resection. It increases the percentage of total removal of the tumor. It should be used within the window period of the action (4–12 h). Keywords: 5-Aminolevulinic acid, Malignant glioma, Fluorescence guided surgery, Protophophrin IX, Extent of resectionhttp://www.sciencedirect.com/science/article/pii/S1015958417302476 |
| spellingShingle | Danny Tat Ming Chan Hsieh Yi-Pin Sonia Wai Sang Poon 5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience Asian Journal of Surgery |
| title | 5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience |
| title_full | 5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience |
| title_fullStr | 5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience |
| title_full_unstemmed | 5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience |
| title_short | 5-Aminolevulinic acid fluorescence guided resection of malignant glioma: Hong Kong experience |
| title_sort | 5 aminolevulinic acid fluorescence guided resection of malignant glioma hong kong experience |
| url | http://www.sciencedirect.com/science/article/pii/S1015958417302476 |
| work_keys_str_mv | AT dannytatmingchan 5aminolevulinicacidfluorescenceguidedresectionofmalignantgliomahongkongexperience AT hsiehyipinsonia 5aminolevulinicacidfluorescenceguidedresectionofmalignantgliomahongkongexperience AT waisangpoon 5aminolevulinicacidfluorescenceguidedresectionofmalignantgliomahongkongexperience |