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01-07-2012 | Original Article

Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies

Authors: Georg Widhalm, Georgi Minchev, Adelheid Woehrer, Matthias Preusser, Barbara Kiesel, Julia Furtner, Aygül Mert, Antonio Di Ieva, Boguslaw Tomanek, Daniela Prayer, Christine Marosi, Johannes A. Hainfellner, Engelbert Knosp, Stefan Wolfsberger

Published in: Neurosurgical Review | Issue 3/2012

Abstract

Stereotactic biopsies represent a routine neurosurgical procedure for the diagnosis of intracranial lymphomas and selected diffusely infiltrating gliomas. Acquisition of tissue samples that do not allow correct tumor typing and grading is, however, not uncommon. Five-aminolevulinic acid (5-ALA) has been shown to accumulate in malignant tumor tissue. The aim of this study was to prospectively investigate the clinical usability of 5-ALA for intraoperative detection of representative tissue in stereotactic tumor biopsies. Fifty consecutive patients underwent frameless stereotactic biopsy for a suspected brain tumor. 5-ALA was administered 4 h before anesthesia. Serial biopsy samples were obtained and intraoperatively checked for 5-ALA fluorescence (strong, vague, or none) using a modified neurosurgical microscope. All samples were examined for the presence of representative tumor tissue according to neuroimaging (MRI, positron emission tomography, and/or chemical shift imaging) and histopathological parameters. Visible 5-ALA fluorescence was observed in 43/50 patients (strong in 39 and vague fluorescence in four cases). At biopsy target, 52/53 samples of glioblastomas, 9/10 samples of gliomas grade III, and 14/16 samples of lymphomas revealed strong 5-ALA fluorescence. Samples with strong 5-ALA fluorescence were only observed at, but not outside the biopsy target. All tissue samples with strong 5-ALA fluorescence were representative according to our neuroimaging and histopathological criteria (positive predictive value of 100%). Our data indicate that strong 5-ALA fluorescence is a reliable and immediately available intraoperative marker of representative tumor tissue of malignant gliomas and intracranial lymphomas in stereotactic biopsies. Thereby, the application of 5-ALA in stereotactic brain tumor biopsies may in future reduce costs for operating room and neuropathology and may decrease procedure-related morbidity.

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Title: Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies
Authors: Georg Widhalm
Georgi Minchev
Adelheid Woehrer
Matthias Preusser
Barbara Kiesel
Julia Furtner
Aygül Mert
Antonio Di Ieva
Boguslaw Tomanek
Daniela Prayer
Christine Marosi
Johannes A. Hainfellner
Engelbert Knosp
Stefan Wolfsberger
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Neurosurgical Review / Issue 3/2012
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-012-0374-5

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Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies

Abstract

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Abstract

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