Year: 2011
Type: article
Abstract: INTRODUCTION: Greater extent of resection for low-grade glioma patients corresponds with improved clinical outcome, yet remains a central challenge to the neurosurgical oncologist.Although 5-aminolevulinic acid (5-ALA)-induced tumor fluorescence is a strategy that can improve glioma extent of resection, only glioblastomas routinely fluoresce following 5-ALA administration.Intraoperative confocal microscopy adapts conventional confocal technology to a hand-held probe that provides real-time fluorescent imaging at up to 1000-fold magnification.We report a combined approach using intraoperative confocal microscopy to visualize 5-ALA tumor fluorescence in low-grade gliomas during the course of microsurgical resection.METHODS: Following 5-ALA administration, newly diagnosed low-grade glioma patients underwent microsurgical resection.Intraoperative confocal microscopy was conducted at (1) the initial encounter with the tumor, (2) the midpoint of tumor resection, and (3) the presumed brain-tumor interface.Histopathological analysis of these sites correlated tumor infiltration with intraoperative cellular tumor fluorescence.RESULTS: Ten consecutive patients with World Health Organization (WHO) grades I and II gliomas underwent microsurgical resection with 5-ALA and intraoperative confocal microscopy.Macroscopic tumor fluorescence was not evident in any patient.However, in each case, intraoperative confocal microscopy identified tumor fluorescence at a cellular level, a finding that corresponded to tumor infiltration on matched histological analyses.CONCLUSIONS: Intraoperative confocal microscopy can visualize cellular 5-ALA-induced tumor fluorescence within WHO grades I and II lowgrade gliomas and at the brain-tumor interface.To assess the clinical value of 5-ALA for high-grade gliomas in conjunction with neuronavigation and for low-grade gliomas in combination with intraoperative confocal microscopy and neuronavigation, a phase IIIa randomized, placebo-controlled trial (BALANCE) is underway at our institution.
Source: Neuro-Oncology
Authors: L. A. Snyder, N. Honea, S. W. Coons, J. Eschbacher, K. A. Smith, R. F. Spetzler, N. Sanai, M. D. Groves, J. DeGroot, I. Tremont, A. Forman, S. Kang, B.-L. Pei, W. Julie, D. Schultz, Y. Yuan, N. Guha, W.-J. Hwu, N. Papadopoulos, K. Camphausen, W. A. Yung, T. Ryken, S. K. Johnston, C. Graham, S. Grimm, H. Colman, J. Raizer, M. C. Chamberlain, M. M. Mrugala, J. E. Adair, B. C. Beard, D. L. Silbergeld, J. K. Rockhill, H.-P. Kiem, E. Q. Lee, T. T. Batchelor, A. B. Lassman, D. S. Schiff, T. J. Kaley, E. T. Wong, T. Mikkelsen, B. W. Purow, J. Drappatz, A. D. Norden, R. Beroukhim, S. Weiss, B. M. Alexander, C. Sceppa, M. Gerard, S. D. Hallisey, C. A. Bochacki, K. H. Smith, A. M. Muzikansky, P. Y. Wen, D. M. Peereboom, T. Mikkelson, A. E. Sloan, J. N. Rich, J. G. Supko, X. Ye, C. Brewer, K. Lamborn, M. Prados, S. A. Grossman, J.-J. Zhu, L. D. Recht, H. Colman, S. Kesari, L. J. Kim, A. H. Balch, C. C. Pope, M. Brulotte, A. P. Beelen, M. C. Chamberlain, E. T. Wong, Z. Ram, P. H. Gutin, R. Stupp, J. Marsh, K. McDonald, H. Wheeler, C. Teo, L. Martin, L. Palmer, M. Rodriguez, M. Buckland, E.-S. Koh, M. Back, B. Robinson, D. Joseph, A. K. Nowak, R. Saito, Y. Sonoda, Y. Yamashita, M. Kanamori, T. Kumabe, T. Tominaga, J. Rodon, H. A. Tawbi, A. L. Thomas, D. D. Amakye, C. Granvil, Y. Shou, J. Dey, S. Buonamici, R. Dienstmann, A. C. Mita, R. Dummer, M. Hutterer, N. Martha, E. Sabine, G. Thaddaus, S. Florian, M. Christine, O. Stefan, G. Richard, M. Martin, B. Johanna, T. Jochen, H. Ullrich, W. Wolfgang, V. Peter, S. Gunther, K. M. Field, L. Cher, H. Wheeler, E. Hovey, A. K. Nowak, J. Simes, K. Sawkins, T. France, C. Brown, CABARET COGNO Investigators, M. K. Nicholas, S. Chmura, N. Paleologos, H. Krouwer, M. Malkin, L. Junck, N. A. Vick, R. V. Lukas, K. A. Jaeckle, S. K. Anderson, M. Kosel, J. Sarkaria, P. Brown, P. J. Flynn, J. C. Buckner, E. Galanis, T. Batchelor, S. Grossman, S. Brem, G. Lesser, A. Voloschin, L. B. Nabors, T. Mikkelsen, S. Desideri, J. Supko, D. Peereboom, M. Westphal, T. Pietsch, F. Bach, O. Heese, OSAG-101 Study Group, J. J. Vredenburgh, A. Desjardins, D. A. Reardon, K. B. Peters, J. P. Kirkpatrick, J. E. Herndon, A. D. Coan, L. Bailey, D. Janney, C. Lu, H. S. Friedman, A. Desjardins, D. A. Reardon, K. B. Peters, J. E. Herndon, S. Gururangan, J. Norfleet, H. S. Friedman, J. J. Vredenburgh, A. B. Lassman, T. J. Kaley, L. M. DeAngelis, A. Hormigo, I. K. Mellinghoff, D. D. Otap, J. Seger, L. A. Doyle, E. Ludwig, M. E. Lacouture, K. S. Panageas, A. Rezazadeh, R. V. LaRocca, T. W. Vitaz, W. G. Villanueva, J. Hodes, L. Haysley, D. Pertschuk, T. F. Cloughesy, S. M. Chang, M. K. Aghi, M. A. Vogelbaum, L. M. Liau, B. Shafa, D. J. Jolly, C. E. Ibanez, O. D. Perez, J. M. Robbins, H. E. Gruber, E. A. Maher, C. Stewart, K. Hatanpaa, J. Raisanen, T. Mashimo, X.-L. Yang, C. Muralidhara, C. Madden, A. Ramachandran, B. Mickey, R. Bachoo
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4239031616