Quantification of PpIX-fluorescence of cerebral metastases: a pilot study

Knipps, Johannes; Fischer, Igor; Neumann, Lisa Margarete; Rapp, Marion; Dibué-Adjei, Maxine; Saß, Christiane Freiin von; Placke, Jan‐Malte; Mijderwijk, Hendrik-Jan; Steiger, Hans‐Jakob; Sabel, Michael; Cornelius, J.F.; Kamp, Marcel A.

doi:10.1007/s10585-019-09986-x

Cited by 11 publications

(12 citation statements)

References 50 publications

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“…Although the use of 5-ALA in the surgical resection of high-grade gliomas and cases of metastasis has been widely documented in the literature, [6][7][8][9][10][11] consistent findings of fluorescence have been reported regarding other tumors, including benign and non-neoplastic lesions. 3,4 There are few available articles 29,33,37 describing the use of 5-ALA fluorescence in those differential diagnoses.…”

Section: Discussionmentioning

confidence: 87%

“…[3][4][5] These promising results evolved to distinct applications in recent laboratory and translational studies. [6][7][8][9][10][11] Over the years, 5-ALA has also been introduced in the treatment of other intracranial tumors, [6][7][8][9][10][11] especially in cases of metastases [6][7][8] and meningiomas. [9][10][11] Routinely used in Europe, Asia and Australia, 5-ALA was approved by the United States Food and Drug Administration (FDA) in 2017.…”

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confidence: 99%

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Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Silva

Ramina

Neto

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as ‘5-ALA free’ or ‘5-ALA residual’. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the ‘5-ALA free’ resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease. Conclusion Fluorescence with 5-ALA can be observed in lesions other than malignant gliomas or metastases, including meningiomas, hemangioblastomas, pilocytic astrocytomas, and lymphomas. Although there is need for further evidence for the use of 5-ALA beyond high-grade gliomas, it may be a safe and reliable tool to improve resection in positive tumors or to guide the histopathologic analysis in biopsies.

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Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Silva

Ramina

Neto

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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“…5-aminolevulinic acid-guided fluorescence was first introduced in malignant glioma surgery as an adjuvant tool for optimizing the removal of these tumors, 7,16,17 leading to increased progression free survival. 7,8,17 Over the years, its vibrant application has been introduced and studied in other intracranial neoplasms, such as brain [9][10][11] and spinal cord metastases [18][19][20] and meningiomas. 12,13,21 There is a 5-ALA positive fluorescence ranging from 77 to 96% of the intracranial meningiomas.…”

Section: Discussionmentioning

confidence: 99%

“…The 5-ALA accumulated in the malignant lesion is converted to protoporphyrin IX (PpIX) and, under a blue filter illumination, shows a selective fluorescence, differing normal from infiltrated tissue with high sensitivity and specificity. 8 About 40 to 62% of brain metastasis [9][10][11] and 77 to 96% of intracranial meningiomas 12 can also exhibit 5-ALA fluorescence, so its use may improve the extent of surgical resection. In these cases, there is a special focus in avoiding missed residual tumors, which can compromise local-recurrence rate and progression free survival.…”

Section: Introductionmentioning

confidence: 99%

5-aminolevulinic Acid and Surgical Margin Analysis in Calvarial Metastasis with Pericranium or Dural Extension: Technical Note

Silva

Neto

et al. 2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Metastasis to the calvarium with direct pericranium or dural infiltration may be treated with radical surgical removal in selected cases. We describe microsurgical resection of calvarial metastases with fluorescence-guided technique using 5-aminolevulinic acid (5-ALA) in two female patients with breast cancer. Fluorescence findings were positive in both cases. Margins in the scalp and dural layer were 5-ALA negative at the end of surgical removal. Intraoperative pathology was performed in all cases to confirm if oncological limits were free of disease. One case was 5-ALA positive in the outer layer of the dura-mater and another in the pericranium. At the end of the removal in both cases, the surgical margins were 5-ALA fluorescence-free. Intraoperative pathology confirmed oncological limits of the resection. 5-aminolevulinic acid fluorescence-guided surgery for calvarial metastases with pericranium and/or dural extension seems to be a safe and reliable method to aid the surgical margins for complete removal, possibly delaying or avoiding adjuvant irradiation for progression control.

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“…As the neurosurgeon resects tumor tissue further out in the infiltrative margin, lower tumor cell density results in less or no fluorescence visualization. However, new visualization devices can permit quantification of 5-ALA (PPIX) signal intensity and detection of fluorescence [26], which correlates with tumor cell density [27], and has been also shown to correlate with Ki-67/MIB-1 index [28,29]. Furthermore, 5-ALA induced fluorescence is found with ependymal surfaces in the ventricles which in certain patients may be associated with subependymal spread of their HGG [28,30,31].…”

Section: -Ala: Limitationsmentioning

confidence: 99%

The Neurosurgeon’s Armamentarium for Gliomas: An Update on Intraoperative Technologies to Improve Extent of Resection

Schüpper

Yong

Hadjipanayis

2021

JCM

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Maximal safe resection is the standard of care in the neurosurgical treatment of high-grade gliomas. To aid surgeons in the operating room, adjuvant techniques and technologies centered around improving intraoperative visualization of tumor tissue have been developed. In this review, we will discuss the most advanced technologies, specifically fluorescence-guided surgery, intraoperative imaging, neuromonitoring modalities, and microscopic imaging techniques. The goal of these technologies is to improve detection of tumor tissue beyond what conventional microsurgery has permitted. We describe the various advances, the current state of the literature that have tested the utility of the different adjuvants in clinical practice, and future directions for improving intraoperative technologies.

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Quantification of PpIX-fluorescence of cerebral metastases: a pilot study

Cited by 11 publications

References 50 publications

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

5-aminolevulinic Acid and Surgical Margin Analysis in Calvarial Metastasis with Pericranium or Dural Extension: Technical Note

The Neurosurgeon’s Armamentarium for Gliomas: An Update on Intraoperative Technologies to Improve Extent of Resection

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