Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 6;16(16):2771.
doi: 10.3390/cancers16162771.

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

Alessandro Pesaresi  1 , Pietro La Cava  1 , Marta Bonada  1   2 , Pietro Zeppa  1 , Antonio Melcarne  1 , Fabio Cofano  1 , Pietro Fiaschi  3   4 , Diego Garbossa  1 , Andrea Bianconi  1   3
Affiliations

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

Alessandro Pesaresi et al. Cancers (Basel). .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: aminolevulinic acid; fluorescein; fluorescence; glioblastoma; glioma; maximal safe resection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Visualization in white light (A), FL 560 (B), and FL 400 (C) of the tumor before corticectomy.
Figure 2
Figure 2
Visualization in white light (A), FL 560 (B), and FL 400 (C) of the tumor during resection. In (C), a tumor residual visible on 5-ALA fluorescence, but not on SF or WL, is highlighted with the white asterisk.
Figure 3
Figure 3
Visualization in white light (A), FL 560 (B), and FL 400 (C) of the cavity after complete resection, with no residual tumor visible with any fluorescent dye.
Figure 4
Figure 4
Visualization in white light (A), FL 560 (B), and FL 400 (C) of tumor sample after en-bloc removal.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mladenovsk M., Valkov I., Ovcharov M., Vasilev N., Duhlenski I. High Grade Glioma Surgery—Clinical Aspects and Prognosis. Folia Med. 2021;63:35–41. doi: 10.3897/folmed.63.e55255. - DOI - PubMed
    1. Bianconi A., Koumantakis E., Gatto A., Zeppa P., Saaid A., Nico E., Bruno F., Pellerino A., Rizzo F., Junemann C.V., et al. Effects of Levetiracetam and Lacosamide on survival and seizure control in IDH-wild type glioblastoma during temozolomide plus radiation adjuvant therapy. Brain Spine. 2024;4:102732. doi: 10.1016/j.bas.2023.102732. - DOI - PMC - PubMed
    1. Bonosi L., Marino S., Benigno U.E., Musso S., Buscemi F., Giardina K., Gerardi R., Brunasso L., Costanzo R., Iacopino D.G., et al. Sonodynamic therapy and magnetic resonance-guided focused ultrasound: New therapeutic strategy in glioblastoma. J. Neurooncol. 2023;163:219–238. doi: 10.1007/s11060-023-04333-3. - DOI - PMC - PubMed
    1. Watts C. Surgical management of high-grade glioma: A standard of care. CNS Oncol. 2012;1:181–192. doi: 10.2217/cns.12.26. - DOI - PMC - PubMed
    1. Bianconi A., Prior A., Zona G., Fiaschi P. Anticoagulant therapy in high grade gliomas: A systematic review on state of the art and future perspectives. J. Neurosurg. Sci. 2023;67:236–240. doi: 10.23736/S0390-5616.21.05536-3. - DOI - PubMed

LinkOut - more resources