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Review
. 2022 Jan 26;14(3):617.
doi: 10.3390/cancers14030617.

Effect of 5-Aminolevulinic Acid and Sodium Fluorescein on the Extent of Resection in High-Grade Gliomas and Brain Metastasis

Lasse Cramer Ahrens  1 , Mathias Green Krabbenhøft  1 , Rasmus Würgler Hansen  2 , Nikola Mikic  1   3 , Christian Bonde Pedersen  2 , Frantz Rom Poulsen  2 , Anders Rosendal Korshoej  1   3
Affiliations
Review

Effect of 5-Aminolevulinic Acid and Sodium Fluorescein on the Extent of Resection in High-Grade Gliomas and Brain Metastasis

Lasse Cramer Ahrens et al. Cancers (Basel). .

Abstract

Surgery is essential in the treatment of high-grade gliomas (HGG) and gross total resection (GTR) is known to increase the overall survival and progression-free survival. Several studies have shown that fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) increases GTR considerably compared to white light surgery (65% vs. 36%). In recent years, sodium fluorescein (SF) has become an increasingly popular agent for fluorescence-guided surgery due to numerous utility benefits compared to 5-ALA, including lower cost, non-toxicity, easy administration during surgery and a wide indication range covering all contrast-enhancing lesions with disruption of the blood-brain barrier in the CNS. However, currently, SF is an off-label agent and the level of evidence for use in HGG surgery is inferior compared to 5-ALA. Here, we give an update and review the latest literature on fluorescence-guided surgery with 5-ALA and SF for brain tumors with emphasis on fluorescence-guided surgery in HGG and brain metastases. Further, we assess the advantages and disadvantages of both fluorophores and discuss their future perspectives.

Keywords: 5-ALA; brain metastases; fluorescence-guided surgery; glioblastoma; glioma; resection; sodium fluorescein.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Visualization of a glioblastoma under a surgical microscope with different techniques. (A) white light. (B) 5-aminolevulinic acid. (C) sodium fluorescein.
See this image and copyright information in PMC

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