Combined Fluorescence-Guided Surgery with 5-Aminolevulinic Acid and Fluorescein in Glioblastoma: Technical Description and Report of 100 Cases

Fluorescence-guided resection (FGR) of glioblastomas has been previously explored with the use of 5-amivelulinic acid (5-ALA) and sodium fluoresceine (SF), allowing us to maximize the extent of resection (EoR). In this study, we highlight the most relevant concerns regarding this technique and prese...

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Published in:Cancers 2024-08, Vol.16 (16), p.2771
Main Authors: Pesaresi, Alessandro, La Cava, Pietro, Bonada, Marta, Zeppa, Pietro, Melcarne, Antonio, Cofano, Fabio, Fiaschi, Pietro, Garbossa, Diego, Bianconi, Andrea
Format: Article
Language:English
Subjects:
Aminolevulinic acid
Brain cancer
Drug approval
Fluorescein
Fluorescence
Glioblastoma
Glioblastoma multiforme
Glioma
Light
Medical centers
Medical prognosis
Medical research
Medicine, Experimental
Metabolism
Patients
Side effects
Surgery
Surgical techniques
Tumors
Visualization
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container_issue 16
container_start_page 2771
container_title Cancers
container_volume 16
creator Pesaresi, Alessandro
La Cava, Pietro
Bonada, Marta
Zeppa, Pietro
Melcarne, Antonio
Cofano, Fabio
Fiaschi, Pietro
Garbossa, Diego
Bianconi, Andrea
description Fluorescence-guided resection (FGR) of glioblastomas has been previously explored with the use of 5-amivelulinic acid (5-ALA) and sodium fluoresceine (SF), allowing us to maximize the extent of resection (EoR). In this study, we highlight the most relevant concerns regarding this technique and present the methods and results from the experience of our center. A case series of 100 patients operated on in AOU Città della Salute e della Scienza in Turin with a histological diagnosis of glioblastoma (grade IV, according to WHO 2021) was retrospectively analyzed. Both 5-ALA and SF were administered and intraoperatively assessed with an optical microscope. 5-ALA is the only approved drug for FGR in glioblastoma, reporting an increased EoR. Nevertheless, SF can be positively used in addition to 5-ALA to reduce the risk of false positives without increasing the rate of adverse effects. In our experience, SF was used to guide the initial phase of resection while 5-ALA was used to visualize tumor spots within the surgical cavity. In 96% of cases, gross total resection was achieved, with supra-maximal resection in 11% of cases. Combined FGR using 5-ALA and SF seems to be a promising method of increasing the extent of resection and to improving the prognosis in glioblastoma patients.
doi_str_mv 10.3390/cancers16162771
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subjects Aminolevulinic acid
Brain cancer
Drug approval
Fluorescein
Fluorescence
Glioblastoma
Glioblastoma multiforme
Glioma
Light
Medical centers
Medical prognosis
Medical research
Medicine, Experimental
Metabolism
Patients
Side effects
Surgery
Surgical techniques
Tumors
Visualization
title Combined Fluorescence-Guided Surgery with 5-Aminolevulinic Acid and Fluorescein in Glioblastoma: Technical Description and Report of 100 Cases
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