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01-01-2018 | Review

Various shades of red—a systematic analysis of qualitative estimation of ALA-derived fluorescence in neurosurgery

Authors: Marcel A. Kamp, Zarela Krause Molle, Christopher Munoz-Bendix, Marion Rapp, Michael Sabel, Hans-Jakob Steiger, Jan F. Cornelius

Published in: Neurosurgical Review | Issue 1/2018

Abstract

5-Aminolevulinic acid (5-ALA)–fluorescence-guided resection is well established in many neuro-oncologic centers. Different classifications of 5-ALA-induced fluorescence have been reported. The aim of the systematic analysis was to evaluate the frequency of graduations, definitions, and designations of 5-ALA-induced fluorescence qualities. A systematic database search of PubMed was performed to identify studies reporting (1) on 5-ALA fluorescence-guided either spinal or cranial surgery, (2) on qualitative estimation and/or categorization of 5-ALA-induced fluorescence, (3) in English, and (4) were published as peer-reviewed original studies. Totally, 93 studies were identified. Different classification systems of 5-ALA-induced fluorescence were found. Over 60 % of the included studies used a dichotomized categorization of 5-ALA-induced fluorescence and 27.5 % of studies distinguished two different intensities of 5-ALA fluorescent tissue in addition to non-fluorescing tissue. More than 50 % of studies explicitly defined criteria for categorization of 5-ALA-induced fluorescence. The major limitation of the present analysis might be that it mainly comprises data from retrospective, uncontrolled, non-randomized trials. However, a precise definition of each 5-ALA-induced fluorescence quality is essential. Although dichotomized classification is the most common and simple graduation system, it may not be suitable for every clinical or scientific task. A three-level 5-ALA-induced fluorescence classification with precise definition of each fluorescence quality and their correlation with histological features would be more useful and reproducible in these cases.

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Title: Various shades of red—a systematic analysis of qualitative estimation of ALA-derived fluorescence in neurosurgery
Authors: Marcel A. Kamp
Zarela Krause Molle
Christopher Munoz-Bendix
Marion Rapp
Michael Sabel
Hans-Jakob Steiger
Jan F. Cornelius
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 1/2018
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-016-0745-4

At a glance: The STEP trials

Springer Medicine

Various shades of red—a systematic analysis of qualitative estimation of ALA-derived fluorescence in neurosurgery

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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