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Prognostic value of ventricular wall fluorescence during 5-aminolevulinic-guided surgery for glioblastoma

  • Experimental research
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Abstract

Background

The meaning of the ventricular wall fluorescence during 5-aminolevulinic (5-ALA)-guided surgery in patients with glioblastoma (GBM) is still unknown. The authors studied the association between ventricle fluorescence, clinical outcome and survival, and described the histopathological findings of selective biopsies from the ventricular wall.

Methods

One hundred and forty patients diagnosed of GBM underwent fluorescence-guided surgery (FGS); 65 of them were naive GBM and ventricle fluorescence during surgery was annotated prospectively. Selective biopsies were collected from the ventricular wall when possible. Clinical and radiological data were registered, including age, Karnofsky Performance Scale (KPS) score, presence of hydrocephalus, overall survival (OS), tumour volume and location (periventricular vs non-periventricular) and leptomeningeal dissemination.

Results

During FGS the ventricle wall was opened just when the tumour was periventricular in the preoperative MRI (45 out of 65). In 28 of them (60 %) the fluorescence extended far away from the site of opening, while in 17 it ended just in the few millimetres around the tumour. All four patients who developed hydrocephalus had periventricular tumours and the ventricle wall had been opened during surgery. Statistically significant differences were seen in OS according to periventricular location (15 m vs 33 m, P = 0.008 log rank). However, there was not significant relationship between ventricle fluorescence and hydrocephalus (P = 0.75), nor survival (14 m vs 15.5 m, P = 0.64).

Conclusions

Preoperative MRI predicts if the ventricle will be opened using the 5-ALA fluorescence, according to tumour location. It does not predict, however if the ventricle wall is going to be fluorescent or not. The fluorescence of the ventricle wall is not a predictor for complications or survival. Periventricular tumour location is an independent bad prognostic factor in GBM.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Clínica Universidad de Navarra, C/Pio XII 36, 31008, Pamplona, Navarra, Spain

    Sonia Tejada-Solís, Guillermo Aldave-Orzaiz, Eva Pay-Valverde, Miguel Marigil-Sánchez & Ricardo Díez-Valle

  2. Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain

    Miguel Angel Idoate-Gastearena

Authors
  1. Sonia Tejada-Solís
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  2. Guillermo Aldave-Orzaiz
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  3. Eva Pay-Valverde
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  4. Miguel Marigil-Sánchez
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  5. Miguel Angel Idoate-Gastearena
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  6. Ricardo Díez-Valle
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Corresponding author

Correspondence to Sonia Tejada-Solís.

Additional information

Comment

This analysis by Sonia Tejada-Solís and co-workers is based on a retrospective assessment of 141 glioblastoma patients operated on using 5-ALA for fluorescence-guided resections. In particular, the authors address the question of whether fluorescence, which is non-uniformly visible in the ependyma if tumours reach the ventricles, is of prognostic significance (regarding survival and complications) and whether fluorescence represents infiltration or not. The main finding is that no differences in survival were found between patients with extensive ependymal fluorescence (which has been observed to be unspecific) or not, which implies that broadly fluorescent ependyma should not be resected, especially since fluorescence was unspecific in three cases. These are novel and interesting data, which expand the literature on fluorescence-guided resections using 5-ALA.

Walter Stummer, Germany

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Tejada-Solís, S., Aldave-Orzaiz, G., Pay-Valverde, E. et al. Prognostic value of ventricular wall fluorescence during 5-aminolevulinic-guided surgery for glioblastoma. Acta Neurochir 154, 1997–2002 (2012). https://doi.org/10.1007/s00701-012-1475-1

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  • DOI: https://doi.org/10.1007/s00701-012-1475-1

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