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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Fluorescence-based measurement of real-time kinetics of Protoporphyrin IX after 5-Aminolevulinic acid administration in human in situ malignant gliomas

Fluoreszenzbasierte Messung der Echtzeitkinetik von Protoporphyrin IX nach Verabreichung von 5-Aminolävulinsäure in malignen humanen Gliomen

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  • presenting/speaker Sadahiro Kaneko - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Eric Suero Molina - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Christian Ewelt - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Nils Warneke - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
  • Walter Stummer - Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP200

doi: 10.3205/19dgnc536, urn:nbn:de:0183-19dgnc5363

Published: May 8, 2019

© 2019 Kaneko et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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Objective: It is well established that use of Five-aminolevulinic acid (5-ALA) what elicites the accumulation of protoporphyrin IX (PpIX) for fluorescence-guided resections of malignant gliomas. Although 5-ALA is recommended to be administered 3 hours before surgery, the time-dependency of tumor fluorescence has not yet been evaluated in humans. We aimed to investigate the time-dependency of PpIX by measuring fluorescence intensities in tumors at various time points during surgery.

Methods: Patients took 5-ALA (20 mg/kg b.w.) 3–4 hours before surgery. Fluorescence intensities and estimated tumor PpIX concentrations were measured in the tumor tissues with a hyperspectral camera. PPIX concentrations was calculated with using hyperspectral imaging and fluorescence phantoms with known PPIX concentrations.

Results: 201 samples from 68 patients were evaluated in this study. On average, maximum values of calculated Fluorescence intensities and PPIX concentrations were observed between 7 and 8 hours after 5-ALA administration. Both Fluorescence intensities and PPIX concentrations distinguished strong and weak fluorescence. Moreover, grade IV gliomas had higher average of value than grade III gliomas.

Conclusion: In malignant glioma tissue, we found that fluorescence after 5-ALA administration peaked later than previously thought. In consequence, 5-ALA should be administered 4-5 hours before surgery.