5-Aminolevulinic Acid Fluorescence in High Grade Glioma Surgery : Surgical Outcome, Intraoperative Findings, and Fluorescence Patterns

Abstract EN

Background.

5-Aminolevulinic acid (5-ALA) fluorescence is a validated technique for resection of high grade gliomas (HGG); the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients.

Methods.

Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated.

Surgical outcome was evaluated by assessing the resection rate as gross total resection (GTR)>98% and GTR>90%.

We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec.

WHO).

Results.

94 patients were finally enrolled.

Overall GTR>98% and GTR>90% was achieved in 93% and 100% of patients.

Extent of resection (GTR>98%) was dependent on tumor location, tumor grade (P<0.05), and tumor size (P<0.05).

In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57%) (P<0.01) and recurrent (60%) tumors.

Conclusions.

5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias.

Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.