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01-08-2013 | Original Paper

The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors

Authors: M. Preuß, C. Renner, W. Krupp, H. Christiansen, L. Fischer, A. Merkenschlager, W. Kieß, W. Müller, N. Manzo, J. Meixensberger, U. Nestler

Published in: Child's Nervous System | Issue 8/2013

Abstract

Introduction

Whereas in the adult population 5-Aminolevulinic acid (5-ALA) fluorescence guidance has been widely accepted for improving the extent of tumor resection, the application in children remains an off-label use. Even though most pediatric study protocols require a complete resection for improving outcome parameters, only few pediatric patients have been operated with fluorescence guidance, and it remains questionable, whether and which pediatric tumors show useful fluorescence. We present casuistic reports of application of 5-ALA in children collected from three different neurosurgical departments.

Patients and methods

In children with suspected malignant intracerebral tumor or recurrence, individual informed consent was obtained in each case from the parents. 5-ALA was administered according to the adult protocol, with 20 mg/kg, 2 h before induction of anesthesia. We retrospectively analyzed 18 patients (13 male, 5 female; age 3–18 years), using the intraoperative neurosurgical protocol, the postoperative MRI results, and the follow-up clinical examinations.

Results

The use of 5-ALA fluorescence guidance proved to be safe in our group of pediatric patients. Fluorescence guidance was most useful for recurrent glioblastoma resection. Medulloblastoma tissue displayed fluorescence only inconsistently, and most pilocytic astrocytoma remained without staining. Ganglioglioma showed partial staining in the central tumor areas, without allowing the use for circumferent resection.

Conclusion

The off-label use of 5-ALA fluorescence guidance in pediatric patients appears to be most useful in recurrent high-grade gliomas. Fluorescence accumulation in other pediatric brain tumor entities is not predictable and should be evaluated in future clinical studies before being integrated into the current treatment protocols.

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Title: The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors
Authors: M. Preuß
C. Renner
W. Krupp
H. Christiansen
L. Fischer
A. Merkenschlager
W. Kieß
W. Müller
N. Manzo
J. Meixensberger
U. Nestler
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 8/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-013-2159-8

At a glance: The STEP trials

Springer Medicine

The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors

Abstract

Introduction

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

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