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Acta Neurochirurgica
Published in: Acta Neurochirurgica 6/2013

01-06-2013 | Clinical Article -Neurosurgical Techniques

5-aminolevulinic acid (5-ALA) fluorescence guided surgery of high-grade gliomas in eloquent areas assisted by functional mapping. Our experience and review of the literature

Authors: Alessandro Della Puppa, Serena De Pellegrin, Elena d’Avella, Giorgio Gioffrè, Marta Rossetto, Alessandra Gerardi, Giuseppe Lombardi, Renzo Manara, Marina Munari, Marina Saladini, Renato Scienza

Published in: Acta Neurochirurgica | Issue 6/2013

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Abstract

Background

Only few data are available on the specific topic of 5-aminolevulinic acid (5-ALA) guided surgery of high-grade gliomas (HGG) located in eloquent areas. Studies focusing specifically on the post-operative clinical outcome of such patients are yet not available, and it has not been so far explored whether such approach could be more suitable for some particular subgroups of patients.

Methods

Patients affected by HGG in eloquent areas who underwent surgery assisted by 5-ALA fluorescence and intra-operative monitoring were prospectively recruited in our Department between June 2011 and August 2012. Resection rate was reported as complete resection of enhancing tumor (CRET), gross total resection (GTR) >98 % and GTR > 90 %. Clinical outcome was evaluated at 7, 30, and 90 days after surgery.

Results

Thirty-one patients were enrolled. Resection was complete (CRET) in 74 % of patients. Tumor removal was stopped to avoid neurological impairment in 26 % of cases. GTR > 98 % and GTR > 90 % was achieved in 93 % and 100 % of cases, respectively. First surgery and awake surgery had a CRET rate of 80 % and 83 %, respectively. Even though at the first-week assessment 64 % of patients presented neurological impairment, there was a 3 % rate of severe morbidity at the 90th day assessment. Newly diagnosed patients had a significantly lower morbidity (0 %) and post-operative higher median KPS. Both pre-operative neurological condition and improvement after corticosteroids resulted significantly predictive of post-operative functional outcome.

Conclusions

5-ALA surgery assisted by functional mapping makes high HGG resection in eloquent areas feasible , through a reasonable rate of late morbidity. This emerges even more remarkably for selected patients.
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Metadata
Title
5-aminolevulinic acid (5-ALA) fluorescence guided surgery of high-grade gliomas in eloquent areas assisted by functional mapping. Our experience and review of the literature
Authors
Alessandro Della Puppa
Serena De Pellegrin
Elena d’Avella
Giorgio Gioffrè
Marta Rossetto
Alessandra Gerardi
Giuseppe Lombardi
Renzo Manara
Marina Munari
Marina Saladini
Renato Scienza
Publication date
01-06-2013
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 6/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-013-1660-x

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