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
Case Reports
. 2025 Feb 16;17(2):e79083.
doi: 10.7759/cureus.79083. eCollection 2025 Feb.

Maximal Intraoperative 5-Aminolevulinic Acid Fluorescence During Surgical Resection of Multiple Lesions in Multifocal Glioblastoma to Achieve Greater Extent of Resection: A Case Report

Javier A Jacobo  1 , Jorge Aristizabal  2 , Andres F Cardona-Zorrilla  1
Affiliations
Case Reports

Maximal Intraoperative 5-Aminolevulinic Acid Fluorescence During Surgical Resection of Multiple Lesions in Multifocal Glioblastoma to Achieve Greater Extent of Resection: A Case Report

Javier A Jacobo et al. Cureus. .

Abstract

Multifocal glioblastoma represents a therapeutic challenge with conflicting evidence on treatment, though it appears that the extent of resection also plays an important role in this disease. The use of 5-aminolevulinic acid has been shown to improve the extent of resection in high-grade gliomas; however, there is little information about its use in multifocal glioblastoma. We present the case of a 79-year-old patient with distant glial lesions who underwent surgery for the resection of a right temporal and a right occipital lesion at the same surgical time. Intraoperative findings and postsurgical events are described in this report. This case shows that resection of multiple lesions in a patient with multifocal glioblastoma using intraoperative 5-aminolevulinic acid fluorescence is feasible and safe.

Keywords: 5-ala; fluorescence; glioblastoma; multifocal; surgery.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative gadolinium-contrast-enhanced T1-weighted MRI showing an enhancing lesion at the right temporal pole and the right occipital lobe (white arrows)
Figure 2
Figure 2. Intraoperative findings for the occipital lesion
(A) Surgical cavity under white light shows normal glial tissue at the borders (black arrow). (B) Under the blue light filter, a residue is found with strong fluorescence (white arrow), and a less strong fluorescence is shown at the limits of the surgical cavity indicating infiltrative tumor tissue (white star). The less intense fluorescence is related to tumor infiltration beyond the limits of the contrast enhancement in the MRI and helps achieve supratotal resection in some described cases [5].
Figure 3
Figure 3. Intraoperative view of the temporal lesion
(A) A view of the temporal lobe under white light. The black arrow points at the superficial Sylvian vein. The black star is located at the initial corticotomy near the temporal pole. (B) Surgical cavity under blue light. The white star is located at the surgical cavity showing a strong fluorescence by the high-grade tumor.
Figure 4
Figure 4. Postoperative MRI showing complete resection of the temporal (A) and occipital (B) lesions.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Author corrections: EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Weller M, van den Bent M, Preusser M, et al. Nat Rev Clin Oncol. 2022;19:357–358. - PMC - PubMed
    1. The oncological role of resection in newly diagnosed diffuse adult-type glioma defined by the WHO 2021 classification: a review by the RANO resect group. Karschnia P, Gerritsen JK, Teske N, ey al. Lancet Oncol. 2024;25:404. - PubMed
    1. Supramaximal resection: retrospective study on IDH-wildtype glioblastomas based on the new RANO-resect classification. Tropeano MP, Raspagliesi L, Bono BC, et al. Acta Neurochir (Wien) 2024;166:196. - PubMed
    1. Patterns of care and survival in patients with multifocal glioblastoma: a Danish cohort study. Trip AK, Hedegaard Dahlrot R, Aaquist Haslund C, et al. Neurooncol Pract. 2024;11:421–431. - PMC - PubMed
    1. Use of 5-ALA fluorescence-guided surgery versus white-light conventional microsurgery for the resection of newly diagnosed glioblastomas (RESECT study): a French multicenter randomized phase III study. Picart T, Pallud J, Berthiller J, et al. J Neurosurg. 2024;140:987–1000. - PubMed

Publication types

LinkOut - more resources