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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(01): e35-e42
DOI: 10.1055/s-0041-1739272
Original Article

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

Ampliando as indicações de ácido 5-aminolevulínico em cirugia guiada por fluorescência para diferentes tumores do sistema nervoso central: Uma série de 255 casos na América Latina
Erasmo Barros da Silva Jr 
1   Department of Neurosurgery, Section of Neuro-oncology, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Ricardo Ramina 
1   Department of Neurosurgery, Section of Neuro-oncology, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Maurício Coelho Neto
1   Department of Neurosurgery, Section of Neuro-oncology, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Guilherme Augusto de Souza Machado
1   Department of Neurosurgery, Section of Neuro-oncology, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Marcella Santos Cavalcanti 
2   Departament of Neuropathology, Instituto de Neurologia de Curitiba, Paraná, Brazil
,
Joseph Franklin Chenisz da Silva 
1   Department of Neurosurgery, Section of Neuro-oncology, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
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Abstract

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 255 cases.

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.

Conclusion Fluorescence with 5-ALA can be observed in lesions other than malignant gliomas or metastases, including meningiomas, hemangioblastomas, pilocytic astrocytomas, and lymphomas. Although there is need for further evidence for the use of 5-ALA beyond high-grade gliomas, it may be a safe and reliable tool to improve resection in positive tumors or to guide the histopathologic analysis in biopsies.

Resumo

Introdução A fluorescência com ácido 5-aminolevulínico (5-ALA) é uma ferramenta segura e confiável para a ressecção total de tumores intracranianos, especialmente gliomas malignos e casos de metástase. Neste estudo retrospectivo, analisamos os achados de fluorescência induzida por 5-ALA em diferentes lesões do sistema nervoso central (SNC), visando ampliar as indicações de seu uso no diagnóstico diferencial.

Objetivos Descrever as indicações e resultados da fluorescência com 5-ALA em uma série de 255 casos.

Métodos Em 255 casos consecutivos, registramos idade, sexo, resposta tumoral de fluorescência intraoperatória com 5-ALA, e status de 5-ALA pós-ressecção, bem como as complicações relacionadas ao método. A pós-ressecção foi graduada como “5-ALA livre” ou “5-ALA residual”. O diagnóstico histopatológico foi estabelecido de acordo com a classificação atual da Organização Mundial de Saúde (OMS).

Resultados Houve 195 (76.4%) casos 5-ALA positivos, 124 (63,5%) dos quais foram submetidos a ressecção “5-ALA livre”. Os achados nos casos positivos foram: 135 gliomas; 19 meningiomas; 4 hemangioblastomas; 1 tumor fibroso solitário; 27 metástases; 2 linfomas difusos de grandes células B; 2 radionecroses; 1 doença inflamatória; 2 glioses; 1 cisticercose; e 1 doença relacionada à imunoglobulina G4.

Conclusões Fluorescência com 5-ALA pode ser observada em outras lesões além de gliomas malignos ou metástases, incluindo meningiomas, hemangioblastomas, astrocitomas pilocíticos, e linfomas. Embora haja necessidade de mais evidências para o uso de 5-ALA que não em casos de gliomas de alto grau, sua aplicação pode ser segura e confiável para melhorar a ressecção de tumores positivos ou orientar a análise histopatológica em biópsias.

Keywords

5-aminolevulinic acid - brain cancer - extent of resection

Palavras-chave

ácido 5-aminolevulínico - câncer no cérebro - extensão de ressecção


Publication History

Received: 25 March 2021

Accepted: 16 June 2021

Article published online:
04 January 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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