2012
DOI: 10.1007/s00701-012-1290-8
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5-Aminolevulinic acid-induced protoporphyrin IX fluorescence as immediate intraoperative indicator to improve the safety of malignant or high-grade brain tumor diagnosis in frameless stereotactic biopsies

Abstract: BackgroundFrameless stereotactic biopsies are replacing frame-based stereotaxy as a diagnostic approach to brain lesions. In order to avoid a sampling bias or negative histology, multiple specimens are often taken. This in turn increases the risk of hemorrhagic complications.ObjectiveWe present the use of 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX fluorescence in frameless stereotaxy to improve the procedure duration and yield, and thereby reduce the risk of complications.MethodsPatients with susp… Show more

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Cited by 51 publications
(37 citation statements)
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“…20 Preliminary reports indicate that 5-ALA fluorescence increases the safety and accuracy of stereotactic and endoscopic brain biopsy procedures. 25,31,47 It has been argued that speed and safety are increased by minimizing sampling errors. 25,47 Very few cases of adverse effects associated with use of 5-ALA during glioma surgery have been reported.…”
mentioning
confidence: 99%
See 1 more Smart Citation
“…20 Preliminary reports indicate that 5-ALA fluorescence increases the safety and accuracy of stereotactic and endoscopic brain biopsy procedures. 25,31,47 It has been argued that speed and safety are increased by minimizing sampling errors. 25,47 Very few cases of adverse effects associated with use of 5-ALA during glioma surgery have been reported.…”
mentioning
confidence: 99%
“…25,31,47 It has been argued that speed and safety are increased by minimizing sampling errors. 25,47 Very few cases of adverse effects associated with use of 5-ALA during glioma surgery have been reported. In a series of 74 patients the authors described adverse events (phototoxic reaction, generalized edema) for only 2 patients.…”
mentioning
confidence: 99%
“…It leads to a significantly increased complete resection rate of these diffusely growing tumors and to a significantly enhanced progression-free survival rate after 6 months, translating into a progression-free survival prolongation of 1.5 months as compared to conventional white light resection. [23] The method has also been tested on excised tissue samples during stereotactic biopsy using surgical microscopes [21,[29][30][31]. In the latter case, the diagnostic yield of the fluorescent samples was always 100% (total n = 98).…”
Section: Introductionmentioning
confidence: 99%
“…Aggressive resection of 98% or more of the tumor volume was a significant independent predictor of patient survival (adjusted rate ratio 1.6, 95% CI 1.3-2, p<0.0001) [14][15][16][17] . In recent years, surgery has drawn efforts to improve outcome, using cut of the edge technology like fluorescence visualization of the tumor by 5-aminolevulinic acid, navigation-guided fencepost-procedure, intraoperative neurophysiological monitoring and intraoperative magnetic resonance imaging [18][19][20][21][22][23][24] . Fluorescence guided surgery has been recently added to the neurosurgeon arsenal to improve tumor resection.…”
Section: Introductionmentioning
confidence: 99%