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Yoshinaga Kajimoto, Toshihiko Kuroiwa, Shin-Ichi Miyatake, Tsugumichi Ichioka, Minoru Miyashita, Hidekazu Tanaka and Motomu Tsuji

. Because meningiomas are usually benign and well circumscribed, there is generally little need for fluorescence guidance during surgical treatment of these lesions. Occasionally, however, the lesions become malignant and/or invade important surrounding structures, such as vessels, dura mater, bone, and brain, especially at recurrence. When such invasion occurs, it is common for some tumor remnants to go unnoticed and lead to recurrence. 6–8 Therefore, fluorescence-guided resection may be beneficial for the removal of complicated or malignant meningiomas that have a high

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Walter Stummer, Alexander Novotny, Herbert Stepp, Claudia Goetz, Karl Bise and Hans Jürgen Reulen

charge-coupled device camera optimized for red porphyrin fluorescence visualization by enhanced sensitivity in the wavelength range beyond 600 nm. Target integration increased image brightness. Fluorescence-Guided Resection We began tumor removal by using a conventional microsurgical procedure under white-light illumination, first removing tumor portions that were easily identified, including areas of necrosis. Whenever desired, the surgeon was able to change the illumination mode to identify porphyrin fluorescence and to continue the operation either under violet

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Eric Suero Molina, Johannes Wölfer, Christian Ewelt, André Ehrhardt, Benjamin Brokinkel and Walter Stummer

, background illumination may be considered too weak, requiring a frequent change of the filters to white light for visualizing anatomy, for reorientation, or for hemostasis. Based in part on the acceptance of fluorescence-guided resection using 5-ALA, a second fluorochrome, fluorescein, which is approved for retinal angiography, has recently gained attention in the context of glioma surgery. First described in 1948 by G. E. Moore for finding and resecting intrinsic brain tumors in the age of air ventriculography, 25 Moore discussed possible merits for detecting tumor but

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Ramin A. Morshed, Seunggu J. Han, Darryl Lau and Mitchel S. Berger

G iven the evidence that a greater extent of resection of gliomas is associated with better survival outcomes, it is essential to identify techniques that can promote intraoperative identification of tumor cells. 2 , 7 Thus, fluorescence-guided resection with 5-aminolevulinic acid (ALA) was developed to help enhance visualization of tumor cells intraoperatively. In a Phase III clinical trial that included patients with high-grade gliomas, Stummer et al. 10 compared the impact of 5-ALA fluorescence-guided versus conventional microsurgery on complete tumor

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Jun Shinoda, Hirohito Yano, Shin-Ichi Yoshimura, Ayumi Okumura, Yasuhiko Kaku, Toru Iwama and Noboru Sakai

 GTR 49  <GTR 56 fluorescence-guided resection  yes 32  no 73 adjuvant radiotherapy plus  ACNU 28  interferon plus ACNU 26  cisplatin or carboplatin 51 * AGD = at greatest diameter. Surgical Procedure and Policy After induction of general anesthesia, high-dose fluorescein sodium (20 mg/kg; Alcon Japan Co., Ltd., Tokyo, Japan) is intravenously injected after dural opening at the craniotomy site. We start tumor removal more than 10 minutes after injection of the dye to

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David W. Roberts, Pablo A. Valdés, Brent T. Harris, Kathryn M. Fontaine, Alexander Hartov, Xiaoyao Fan, Songbai Ji, S. Scott Lollis, Brian W. Pogue, Frederic Leblond, Tor D. Tosteson, Brian C. Wilson and Keith D. Paulsen

, : Increased brain tumor resection using fluorescence image guidance in a preclinical model . Lasers Surg Med 35 : 181 – 190 , 2004 4 Collaud S , Juzeniene A , Moan J , Lange N : On the selectivity of 5-aminolevulinic acid-induced protoporphyrin IX formation . Curr Med Chem Anticancer Agents 4 : 301 – 316 , 2004 5 Eljamel MS , Goodman C , Moseley H : ALA and Photofrin fluorescence-guided resection and repetitive PDT in glioblastoma multiforme: a single centre Phase III randomised controlled trial . Lasers Med Sci 23 : 361 – 367 , 2008 6

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Kimon Bekelis, Pablo A. Valdés, Kadir Erkmen, Frederic Leblond, Anthony Kim, Brian C. Wilson, Brent T. Harris, Keith D. Paulsen and David W. Roberts

fluorescence–guided resection images. Fluorescence-guided resection of a skull base meningioma showed varying levels of qualitative and quantitative fluorescence. A histologically confirmed tumor region with large amounts of accumulated PpIX showing high levels of visible fluorescence under blue light excitation (A) with the corresponding white light image (B) , and the quantitative fluorescence spectrum (C) showing the distinctive PpIX spectrum. A region of normal dura showed no visible fluorescence under blue light excitation (D) with the corresponding white light

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Pablo A. Valdés, Frederic Leblond, Anthony Kim, Brent T. Harris, Brian C. Wilson, Xiaoyao Fan, Tor D. Tosteson, Alex Hartov, Songbai Ji, Kadir Erkmen, Nathan E. Simmons, Keith D. Paulsen and David W. Roberts

thinking that these tumors are not amenable to fluorescence-guided resection with this particular biomarker. 17 , 23 Currently, intraoperative tumor tissue detection relies on visual white light inspection, preoperative image guidance, intraoperative imaging 5 including qualitative observation of fluorescence, 4 , 14 , 18 and/or time-consuming, ex vivo diagnosis by a pathologist. 20 Here, we show the advantage of a light-transport modeling-based measurement approach compared with 4 direct but uncorrected spectroscopic metrics for intraoperative fluorescence

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John R. Ruge and Jonathan Liu

W e present a case of 5-ALA fluorescence-guided resection in a child with a primary brain tumor; this agent has been used previously in adult patients to facilitate GTR of malignant gliomas. To our knowledge, the present study is the first case to describe the utilization and safety of 5-aminolevulinic acid in a child; it is also the first use of 5-ALA for a benign pleomorphic xanthoaxtrocytoma. Case Report History and Presentation This 9-year-old girl with no significant medical history presented with a 1-year history of complex partial seizures

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Yoji Tamura, Toshihiko Kuroiwa, Yoshinaga Kajimoto, Yoshihito Miki, Shin-Ichi Miyatake and Masao Tsuji

microscope. Stummer and colleagues 14 reported the usefulness of fluorescence-guided resection with 5-ALA–induced porphyrins for glioblastomas. However, there has not been a report on efforts to detect a brain tumor under an endoscopic fluorescence image using 5-ALA. In the oropharyngolarynx, bladder, uterus, gastrointestinal system, and other areas within the body that do not have a barrier such as the BBB, 5-ALA can easily move from the blood vessels to the neoplasm. Therefore, protoporphyrin IX emits relatively stable fluorescence, and it is possible to detect the