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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Glioblastoma surgery guided by 5-ALA fluorescence and subsequent i-MRI. A histological evaluation

Meeting Abstract

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  • Ralf A. Kockro - Department of Neurosurgery, Klinik Hirslanden, Zürich, Schweiz; Department of Neurosurgery, Universitätsspital, Zürich, Schweiz
  • Sonja B. Hauser - Department of Neurosurgery, Klinik Hirslanden, Zürich, Schweiz; Department of Neurosurgery, Universitätsspital, Zürich, Schweiz
  • Bertrand Actor - Department of Neurosurgery, Klinik Hirslanden, Zürich, Schweiz; Department of Neurosurgery, Universitätsspital, Zürich, Schweiz
  • Johannes Sarnthein - Department of Neurosurgery, Klinik Hirslanden, Zürich, Schweiz; Department of Neurosurgery, Universitätsspital, Zürich, Schweiz
  • René-Ludwig Bernays - Department of Neurosurgery, Klinik Hirslanden, Zürich, Schweiz; Department of Neurosurgery, Universitätsspital, Zürich, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.09.09

doi: 10.3205/14dgnc052, urn:nbn:de:0183-14dgnc0527

Published: May 13, 2014

© 2014 Kockro et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Surgical treatment of glioblastoma remains challenging. New imaging modalities including 5-aminolevulinic (5-ALA) fluorescence and intra-operative MRI (iMRI) may improve surgical resection and prolong survival. We evaluated 5-ALA fluorescence versus low-field iMRI for resection control in glioblastoma surgery.

Method: 14 patients with suspected glioblastoma received surgical treatment using 5-ALA induced fluorescence and frameless navigation. Following complete resection of 5-ALA fluorescent tissue, which was verified by two neurosurgeons, intra-operative low-field MRI (Pole Star, Medtronic) was applied. If areas suspicious of tumor were identified they were biopsied under navigation guidance. Tissue samples were also taken from various 5-ALA enhancing locations before iMRI. All data were collected prospectively and the histological analysis was blinded.

Results: In 13 of 14 cases the diagnosis was glioblastona mulitiforme. One case was lymphoma and excluded from the study. 12 of 13 operations showed 5-ALA fluorescence, one case failed to show fluorescent tissue and was also excluded. In 11 of 12 operations residual contrast enhancement on iMRI was found after complete resection of 5-ALA fluorescent tissue. The histological assessment of 27 samples of the 11 cases which showed contrast enhancing residual tumour on iMRI showed tumour in 9 cases (33.3%), infiltration zone in 7 (25.9%), reactive CNS tissue in 10 (37%) and only 1 case (3.7%) without pathological changes.

Conclusions: Not all glioblastoma tissue shows 5-ALA fluorescence and not all i-MRI contrasting regions contain tumor. I-MRI performed after complete resection of 5-ALA fluorescent tissue shows contrast enhancing regions suspicious of remnant glioblastoma in a very high percentage of cases (92%) and tissue samples taken from these locations reveal tumor or tumor infiltration zone in the majority of cases (58%). This data reveals the sensitivity limitations of 5-ALA fluorescence. However, due to low specificity the extended resection of i-MRI contrast enhancing areas has to be considered with caution in eloquent areas.