Technical Pearls to Effectively Use 5-ALA in Fluorescence-Guided Tumor Resection—5 Lessons from the Operating Room

Pepa, Giuseppe Maria Della; Menna, Grazia; Olivi, Alessandro

doi:10.3390/brainsci13030411

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…The combinational technique of photodynamic therapy (PDT) and fluorescence-guided surgery has been extensively investigated in various types of brain cancer, especially high-grade glioma (HGG), using 5-ALA, which has been approved for clinical use [ 49 , 50 ]. Fluorescence-guided surgery of the pituitary gland tumors has been studied with the use of various photosensitizers, such as 5-ALA, indocyanine green or fluoresceine sodium.…”

Section: Photodynamic Therapymentioning

confidence: 99%

Current Strategies in Photodynamic Therapy (PDT) and Photodynamic Diagnostics (PDD) and the Future Potential of Nanotechnology in Cancer Treatment

Olszowy,

Nowak-Perlak,

Woźniak

2023

Pharmaceutics

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Photodynamic diagnostics (PDD) and photodynamic therapy (PDT) are well-established medical technologies used for the diagnosis and treatment of malignant neoplasms. They rely on the use of photosensitizers, light and oxygen to visualize or eliminate cancer cells. This review demonstrates the recent advancements in these modalities with the use of nanotechnology, including quantum dots as innovative photosensitizers or energy donors, liposomes and micelles. Additionally, this literature review explores the combination of PDT with radiotherapy, chemotherapy, immunotherapy, and surgery for treating various neoplasms. The article also focuses on the latest achievements in PDD and PDT enhancements, which seem to be very promising in the field of oncology.

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Section: Photodynamic Therapymentioning

confidence: 99%

Current Strategies in Photodynamic Therapy (PDT) and Photodynamic Diagnostics (PDD) and the Future Potential of Nanotechnology in Cancer Treatment

Olszowy,

Nowak-Perlak,

Woźniak

2023

Pharmaceutics

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“…Intraoperatively, when it has been surrounded by complex brain anatomy, it takes on more interesting forms and exhibits different hues and shades (Figure 2). One issue that affects the users of 5-ALA fluorescence-guided surgery is the visualization of PpIX at the bottom of deep cavities, 10 and the phantoms can be used to become more familiar and confident with deep-seated lesions (Figure 2C and 2D).…”

Section: Intraoperative Imagesmentioning

confidence: 99%

Tumor Models for Training of Fluorescence-Guided Brain Tumor Resection

Buckley,

Artemiuk,

Cabanac

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Neurosurgical resection of brain tumors is a technically demanding task with a steep initial learning curve. Experience has been shown to improve surgical performance and increase the rates of resection. High-grade gliomas (HGG) are responsible for 65% of all primary malignant central nervous system tumors and are the commonest surgically treated brain tumor worldwide. There is increasing evidence that maximal safe surgical resection of HGG impacts on overall survival. The delineation of tumor tissue (and hence the extent of resection) is improved by the use of intraoperative tumor fluorescence, which is achieved by preoperative oral administration of 5-aminolevulinic acid. This however relies on the surgeon developing a skillset of operating under different light conditions for which specific training and experience are required. METHODS: We propose a novel, affordable, and highly adaptable model for recreating these surgical conditions and thus simulate fluorescence-guided HGG resection outside the operating theater for trainee neuro-oncological surgeons. We present a model incorporating plant-based polysaccharides, doped with protoporphyrin IX (PpIX), into cadaveric brains of animals. RESULTS: We show that the concentrations of polymer and PpIX can be titrated (using previously published data) to produce mechanical and fluorescence properties that model tumor tissue. We validate the simulation in a neurosurgical skills laboratory. Furthermore, we used a mini spectrometer with handheld probe to collect fluorescence signals and validate the spectroscopic signal from the PpIX. CONCLUSION: It is hoped that this model system will be useful in neurosurgical teaching and training courses and to neurosurgeons who want to try out new techniques or equipment in anatomy laboratories.

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