Intraoperative Fluorescence Detection of Malignant Gliomas Using 5-Aminolevulinic Acid

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Background and Aims : Complete surgical resection of glioma is difficult due to its characteristic infiltrative proliferation. However, as the extent of resection directly affects the prognosis of the disease, we evaluated a fluorescent technique using 5-aminolevulinic acid (ALA), an intrinsic precursor of Hem, for accurate intraoperative distinction of tumor cells from normal brain tissues. Methods : We performed intraoperative fluorescent tumor detection after administration of ALA using ALA-induced protoporphyrin Ix (PpIX) as a guide in 11 patients who were preoperatively suspected to have glioma, starting in November, 2001. The extent of removal of the tumor was evaluated using contrast-enhanced MRI, and the localization ALA-induced PpIX in the resected tissues was analyzed histopathologically・ Results : Tumor tissues could be identified in9 of the 11 patients,including subcortical areas invaded by the tumor, and the findings were useful in their resection. ALA-induced PpIX was localized in the cytoplasm of tumor cells, with no untake being noted in normal tissue. Conclusions : Intraoperative fluorescent tumor detection using 5-ALA was useful for increasing tumor resection, and can be performed as a useful diagnostic tool for resection of brain tumors. (Kitakanto Med J 2003 ; 53 : 109〜113)
北関東医学会の論文
2003-05-01