The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors

Abstract

The off-label use of 5-ALA fluorescence guidance in pediatric patients appears to be most useful in recurrent high-grade gliomas. Fluorescence accumulation in other pediatric brain tumor entities is not predictable and should be evaluated in future clinical studies before being integrated into the current treatment protocols.

Fluorescence guided resection and glioblastoma in 2015: A review

“…This was also observed in a Preuss et al study, which reported a consequent series of 18 children that were operated on with FGR . The Preuss data even suggested that improved survival parameters were observed after total GBM resections using FGR . No adverse effect was observed in these studies .…”

“…The Preuss data even suggested that improved survival parameters were observed after total GBM resections using FGR . No adverse effect was observed in these studies . None of these publications reported positive fluorescence levels in pilocytic astrocytomas .…”

“…According to their work, 5‐ALA FGR was very useful in better identifying tumor tissue and achieving gross total resections in GBMs, whereas inconstant fluorescence was detected in medulloblastoma . This was also observed in a Preuss et al study, which reported a consequent series of 18 children that were operated on with FGR . The Preuss data even suggested that improved survival parameters were observed after total GBM resections using FGR .…”

5ALA in pediatric brain tumors is not routinely beneficial

“…To date, 120 cases applying 5ALA in pediatric brain tumors have been published (Table 1) [4][5][6][7][8][9][10][11][12]. Most publications have included only a handful of cases.…”

High-resolution imaging of the central nervous system

“…As a result of these extensive preliminary findings, fluorescence-guided resection is increasingly practiced as a surgical adjunct for treatment of adult gliomas in Europe. Recent studies have also begun extending the technique to the pediatric population for microsurgical resection of highly invasive tumors such as medulloblastoma (Beez et al, 2014;Preuß et al, 2013). Initial results suggest administration of 5-ALA generates fluorescence in anaplastic astrocytoma, glioblastoma, medulloblastoma, and anaplastic ependymoma comparable to the adult population (Beez et al, 2014).…”