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Acta Neurochirurgica
Erschienen in: Acta Neurochirurgica 6/2019

13.04.2019 | Review Article - Pediatric Neurosurgery

5-ALA fluorescence–guided surgery in pediatric brain tumors—a systematic review

verfasst von: Michael Schwake, Stephanie Schipmann, Michael Müther, Michaela Köchling, Angela Brentrup, Walter Stummer

Erschienen in: Acta Neurochirurgica | Ausgabe 6/2019

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Abstract

Background

5-Aminolevulinic acid (5-ALA)-guided resection of gliomas in adults enables better differentiation between tumor and normal brain tissue, allowing a higher degree of resection, and improves patient outcomes. In recent years, several reports have emerged regarding the use of 5-ALA in other brain tumor entities, including pediatric brains tumors. Since gross total resection (GTR) of many brain tumors in children is crucial and the role of 5-ALA-guided resection of these tumors is not clear, we sought to perform a comprehensive literature review on this topic.

Methods

A systematic literature review of EMBASE and MEDLINE/PubMed databases revealed 19 eligible publications encompassing 175 5-ALA-guided operations on pediatric brain tumors. To prevent bias, publications were revised independently by two authors.

Results

We found that 5-ALA-guided resection enabled the surgeons to identify the tumor more easily and was considered helpful mainly in cases of glioblastoma (GBM, 21/27, 78%), anaplastic ependymoma WHO grade III (10/14, 71%), and anaplastic astrocytoma (4/6, 67%). In contrast, cases of pilocytic astrocytomas (PAs) and medulloblastomas 5-ALA-guided surgery did not show consistent fluorescent signals and 5-ALA was considered helpful only in 12% and 22% of cases, respectively. Accumulation of fluorescent porphyrins seems to depend on WHO tumor grading. One important finding is that when 5-ALA-guided resections were considered helpful, the degree of resection was higher than is cases where it was not helpful. The rate of adverse events related to 5-ALA was negligible, especially new postoperative sequelae.

Conclusion

5-ALA could play a role in resection of pediatric brain tumors. However, further prospective clinical trials are needed.
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Metadaten
Titel
5-ALA fluorescence–guided surgery in pediatric brain tumors—a systematic review
verfasst von
Michael Schwake
Stephanie Schipmann
Michael Müther
Michaela Köchling
Angela Brentrup
Walter Stummer
Publikationsdatum
13.04.2019
Verlag
Springer Vienna
Erschienen in
Acta Neurochirurgica / Ausgabe 6/2019
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-019-03898-1

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