Editorial: Use of 5-aminolevulinic acid helps see the way beyond MRI

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Coburger et al.2 present the results of a study in which they demonstrate that 5-aminolevulinic acid (5-ALA) is superior to Gd-DTPA–enhanced intraoperative MRI for histological tumor detection during the course of resection for high-grade gliomas. It doesn't seem to make a difference for metastatic tumors, which is not surprising. With our increasing knowledge that extent of resection significantly impacts not only progression-free survival but also overall survival, we as neurosurgeons are searching for the next biggest impact in patient outcome with our surgical techniques.

We know that in low-grade gliomas there is a trend toward better outcome if

Coburger et al.2 present the results of a study in which they demonstrate that 5-aminolevulinic acid (5-ALA) is superior to Gd-DTPA–enhanced intraoperative MRI for histological tumor detection during the course of resection for high-grade gliomas. It doesn't seem to make a difference for metastatic tumors, which is not surprising. With our increasing knowledge that extent of resection significantly impacts not only progression-free survival but also overall survival, we as neurosurgeons are searching for the next biggest impact in patient outcome with our surgical techniques.

We know that in low-grade gliomas there is a trend toward better outcome if the tumor resection extends beyond the margins demonstrated on imaging. Whether or not this has been proven in high-grade tumors remains to be seen. There is evidence from a recent study by Aldave et al.1 that resection of the 5-ALA–positive material beyond what was seen on contrast-enhancing scans preoperatively provides greater overall survival of patients. This indicates that resections beyond the enhancement and now beyond the 5-ALA–positive tissue can also impact outcome. Therefore this is a timely study that will allow us to push resections even further to achieve a better outcome for our patients.

Disclosure

The author reports no conflict of interest.

References

  • 1

    Aldave GTejada SPay EMarigil MBejarano BIdoate MA: Prognostic value of residual fluorescent tissue in glioblastoma patients after gross total resection in 5-aminolevulinic acid-guided surgery. Neurosurgery 72:9159212012

  • 2

    Coburger JEngelke JScheuerle AThal DRHlavac MWirtz CR: Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA–enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment. Neurosurg Focus 36:2Application of Fluorescent Technology in NeurosurgeryE32014

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Article Information

Please include this information when citing this paper: DOI: 10.3171/2013.12.FOCUS13553.

© AANS, except where prohibited by US copyright law.

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References

1

Aldave GTejada SPay EMarigil MBejarano BIdoate MA: Prognostic value of residual fluorescent tissue in glioblastoma patients after gross total resection in 5-aminolevulinic acid-guided surgery. Neurosurgery 72:9159212012

2

Coburger JEngelke JScheuerle AThal DRHlavac MWirtz CR: Tumor detection with 5-aminolevulinic acid fluorescence and Gd-DTPA–enhanced intraoperative MRI at the border of contrast-enhancing lesions: a prospective study based on histopathological assessment. Neurosurg Focus 36:2Application of Fluorescent Technology in NeurosurgeryE32014

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