O5.10 5-ALA FLUORESCENCE GUIDED RESECTION OF HEMANGIOBLASTOMAS - IS IT USEFUL WITH CONVENTIONAL SURGICAL TOOLS?

• Published in: Neuro-oncology (Charlottesville, Va.) Va.), 2014-09, Vol.16 (suppl 2), p.ii12-ii12
• Main Authors: De Campos, J. M., Sainz, L., Presti, A. L., Ramirez, M., Aguirre, D., Ordonez, C., Daoud, L.
• Format: Article
• Language: English
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/nou174.41

BACKGROUND: The use of 5-aminolevulinic acid (5-ALA) for fluorescent guided malignant glioma surgery has proved to be useful to ensure a complete resection and thus, a best survival result. One report has described its usefulness for the detection of hemangioblastoma fragments at the cyst wall after apparently complete tumor resection. Von Hippel-Lindau disease patients suffer from many CNS hemangioblastomas, requiring multiple surgical procedures for resection of tumors, many times obscured because distorted structures and dense gliotic scars. MATERIAL AND METHODS: In order to test the eventual utility of 5-ALA fluorescent guided surgery in multiple hemangioblastomas, we have performed surgical procedures in two VHL patients for resection of multiple hemangioblastomas. After patient consent and approval by the Ethical Committee, 5-ALA was administered as oral dose 20 mg/kg 3 hours before anesthesia induction. A surgical microscope modified for Protoporphyrin IX (PpIX)fluorescence guidance, and frameless neuronavigation were used for the surgical procedure. After neuronavigated location and microsurgical dissection of tumors, some involved in dense scars, surgical field visualization was performed alternating standard light illumination and violet-blue light mode, to excite PpIX and collect fluorescence by visualization in surgical oculars and registration on a color camera. RESULTS: Both VHL patients had been previously subjected to surgical procedures for resection of previous posterior fossa tumors. In one case, resection of 7 cerebellar and brainstem tumors was planned on neuronavegator after MRI images, and performed; postsurgical MRI showed a one residual tumor, unnoticed during the surgical procedure because dense scarring tissue. In the second patient, 4 tumors were planned for resection, 3 in cerebellum and 1 in brainstem, and all of them were found and resected. In no case red remitted fluorescence was observed during the location, dissection or resection of tumors. Histopathology analysis proved that all 11 tumors were typical hemangioblastomas. One small area with pink remitted fluorescence in the surgical bed of a tumor proved to be just gliosis without tumor cells. CONCLUSIONS: In the present cases, 5-ALA fluorescent guided surgery for multiple hemangioblastoma resections has not been of utility with the regular surgical armamentarium, instead of the above mentioned experience from one author. The different system for fluorescence evaluation