TY - JOUR
T1 - 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
AU - Della Puppa, Alessandro
AU - De Pellegrin, Serena
AU - D'Avella, Elena
AU - Gioffrè, Giorgio
AU - Rossetto, Marta
AU - Gerardi, Alessandra
AU - Lombardi, Giuseppe
AU - Manara, Renzo
AU - Munari, Marina
AU - Saladini, Marina
AU - Scienza, Renato
PY - 2013/6
Y1 - 2013/6
N2 - 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.
AB - 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.
KW - Cortical and sub-cortical stimulation
KW - Eloquent areas
KW - Fluorescence-guided tumor resection
KW - Functional mapping
KW - High grade glioma
KW - Intra-operative monitoring
KW - Neuronavigation
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U2 - 10.1007/s00701-013-1660-x
DO - 10.1007/s00701-013-1660-x
M3 - Article
C2 - 23468036
AN - SCOPUS:84878771805
VL - 155
SP - 965
EP - 972
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 6
ER -