gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Recurrent malignant gliomas and 5-ALA fluorescence guidance: a multicentre phase II study

Meeting Abstract

  • A. Nabavi - Neurochirurgische Klinik, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel
  • H. Thurm - medac GmbH
  • B. Zountsas - Neurochirurgischen Klinik der Krankenanstalten Gilead Bethel, Bielefeld
  • T. Pietsch - Neuropathologie, Universitätsklinikum Bonn
  • H. Lanfermann - Neuroradiologie, Universitätsklinikum Frankfurt
  • U. Pichlmeier - medac GmbH
  • H.M. Mehdorn - Neurochirurgische Klinik, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.10-05

doi: 10.3205/09dgnc244, urn:nbn:de:0183-09dgnc2444

Published: May 20, 2009

© 2009 Nabavi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: To assess the feasibility of 5-Aminolevulinic acid (5ALA) fluorescence-guided resection for recurrent malignant brain tumours.

Methods: We conducted a multicentre prospective, single-arm, uncontrolled phase II study. 36 patients with recurrent glioma (WHO grade III/IV) received 5-ALA prior to surgery. The tumours were resected employing standard microsurgical techniques. Biopsies from pathological and non-pathological areas (as identified under conventional white light) were taken to determine the positive-predictive value (PPV) of 5-ALA induced tissue fluorescence in detecting tumour. PPV was calculated on a patient-based as well as on a biopsy-based basis. Follow-up of patients extended over a period of six months after study surgery.

Results: In the patient-based approach for non-pathological appearing tissue (under white light), fluorescence positively predicted tumour in 79.4% (PPV). Within areas of strong fluorescence, PPV was higher (91.7% compared to that of weak fluorescence 82.4%). On the biopsy level (157 biopsies from non-pathological appearing tissue under white light), the positive predictive value of tissue fluorescence was 93.0%. Again, within areas of strong fluorescence, PPV was higher (96.9%; 95% CI: 89.2% – 99.6%) compared to that of weak fluorescence (90.3%; 95% CI: 82.4% – 95.5%). There were no adverse events pertaining to the study drug.

Conclusions: 5-ALA fluorescence has a high predictive value for the detection of tumour in recurrent gliomas. Prior treatment modalities, such as radiation or chemotherapy do not invalidate the fluorescence guidance with 5-ALA. As in primary malignant gliomas, 5-ALA fluorescence guidance is thus an effective surgical adjunct in the surgery of recurrent malignant gliomas.