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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
Introduction, Objectives, Methods, Results, and Conclusion.
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
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.
Keywords (separated by comma on a single line)
5-aminolevulinic acid; brain cancer; extent of resection
ERASMO BARROS DA SILVA JR, RICARDO RAMINA, MAURICIO COELHO NETO, GUSTAVO SIMIANO JUNG, MARCELLA SANTOS CAVALCANTI, VICTOR FRANDOLOSO