What is the Surgical Benefit of Utilizing 5-Aminolevulinic Acid for Fluorescence-Guided Surgery of Malignant Gliomas?
What is the Surgical Benefit of Utilizing 5-Aminolevulinic Acid for Fluorescence-Guided Surgery of Malignant Gliomas?
复制标题
DOI：
10.1227/neu.0000000000000929
复制
发表时间：
2015-11
期刊：
影响因子：
4.8
通讯作者：
Stummer W
中科院分区：
文献类型：
--
作者：
Hadjipanayis CG;Widhalm G;Stummer W
当前恶性神经胶质瘤患者的神经外科目标是最大限度地安全切除对比增强肿瘤。然而，只有少数患者能够完全切除对比增强肿瘤。造成这种限制的原因之一是在肿瘤边缘手术期间使用传统的白光显微镜难以区分存活的肿瘤和正常的邻近大脑。为了克服这一限制，使用 5-氨基乙酰丙酸 (5-ALA) 的荧光引导手术 (FGS) 已被引入治疗恶性胶质瘤。 FGS 允许术中对恶性神经胶质瘤组织进行可视化，并为神经外科医生提供实时指导，以区分肿瘤与正常大脑，而无需依赖神经导航和大脑移位。口服 5-ALA 后的组织荧光对于识别恶性神经胶质瘤肿瘤组织具有前所未有的高灵敏度、特异性和阳性预测值。 5-ALA 诱导的弥漫性浸润神经胶质瘤中的肿瘤荧光（MRI 对比增强不显着）允许术中识别间变病灶，并为适当的辅助治疗建立准确的组织病理学诊断。与传统的白光切除术相比，5-ALA FGS 使外科医生能够实现显着更高的恶性神经胶质瘤完全切除率。因此，5-ALA FGS 已成为世界各地许多神经外科不可或缺的手术技术和护理标准。我们对使用 5-ALA 进行恶性神经胶质瘤 FGS 的手术益处进行了广泛的文献综述。根据文献，神经外科医生进行 5-ALA FGS 有多种原因，本综述将详细讨论这些原因。
The current neurosurgical goal for patients with malignant gliomas is maximal safe resection of the contrast-enhancing tumor. However, a complete resection of the contrast-enhancing tumor is achieved only in a minority of patients. One reason for this limitation is the difficulty in distinguishing viable tumor from normal adjacent brain during surgery at the tumor margin using conventional white-light microscopy. To overcome this limitation, fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) has been introduced in the treatment of malignant gliomas. FGS permits the intraoperative visualization of malignant glioma tissue and supports the neurosurgeon with real-time guidance for differentiating tumor from normal brain that is independent of neuronavigation and brain shift. Tissue fluorescence after oral administration of 5-ALA is associated with unprecedented high sensitivity, specificity, and positive predictive values for identifying malignant glioma tumor tissue. 5-ALA-induced tumor fluorescence in diffusely infiltrating gliomas with non-significant MRI contrast-enhancement permits intraoperative identification of anaplastic foci and establishment of an accurate histopathological diagnosis for proper adjuvant treatment. 5-ALA FGS has enabled surgeons to achieve a significantly higher rate of complete resections of malignant gliomas as compared to conventional white-light resections. Consequently, 5-ALA FGS has become an indispensable surgical technique and standard of care at many neurosurgical departments around the world. We conducted an extensive literature review concerning the surgical benefit of utilizing 5-ALA for FGS of malignant gliomas. According to the literature, there are a number of reasons for the neurosurgeon to perform 5-ALA FGS, which will be discussed in detail in the current review.