Intraoperative Detection of Malignant Gliomas by 5-Aminolevulinic Acid-induced Porphyrin Fluorescence
Abstract
OBJECTIVE: Survival after surgery and radiotherapy for the treatment of malignant gliomas is linked to the completeness of tumor removal. Therefore, methods that permit intraoperative identification of residual tumor tissue may be of benefit. In a preliminary investigation, we have studied the value of fluorescent porphyrins that accumulate in malignant tissue after administration of a precursor (5-aminolevulinic acid) for labeling of malignant gliomas in nine patients. METHODS: Three hours before the induction of anesthesia, 10 mg 5-aminolevulinic acid/kg body weight was administered orally. Intraoperatively, red porphyrin fluorescence was observed with a 455-nm long-pass filter after excitation with violet-blue (375-440 nm) xenon light and was verified by analysis of fluorescence spectra. Fluorescing and nonfluorescing samples taken from the tumor perimeters were examined histologically or used to study the photobleaching of porphyrins by excitation light and white light from the operating microscope. Plasma and erythrocyte porphyrin levels were determined by fluorescence photometry. RESULTS: Normal brain tissue revealed no porphyrin fluorescence, whereas tumor tissue was distinguished by bright red fluorescence. For a total of 89 tissue biopsies, sensitivity was 85% and specificity was 100% for the detection of malignant tissue. For seven of nine patients, visible porphyrin fluorescence led to further resection of the tumor. Under operating light conditions, fluorescence decayed to 36% in 25 minutes for violet-blue light and in 87 minutes for white light. Plasma and erythrocyte porphyrin contents increased slightly, without exceeding normal levels. CONCLUSION: Our observations suggest that 5-aminolevulinic acid-induced porphyrin fluorescence may label malignant gliomas safely and accurately enough to enhance the completeness of tumor removal.
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Low-grade gliomas exhibited only marginal PpIX fluorescence.
“However, low-grade gliomas exhibited only marginal PpIX fluorescence.”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [47]
In 89 biopsies of grade III or IV gliomas, the sensitivity and specificity of PpIX fluorescence for tumor detection were 85% and 100%, respectively.
“Out of 89 biopsies of grade III or IV gliomas, the sensitivity and specificity of using PpIX fluorescence for tumor detection were 85% and 100%, respectively.”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [47]
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5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy
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- Authors
- Walter, S., Susanne, S., Simon, W., Herbert, S., Clemens, F., Claudia, G., Alwin, E. G., Rainer, K., & Hans, J. R.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- Laser Research Laboratory Institute for Anaesthesiology
- Department of Dermatology Heinrich-Heine-University, Dusseldorf, Germany
- Department of Neurosurgery Institute for Anaesthesiology
- Heinrich Heine University Düsseldorf (DE)
- Klinikum Grojβhadern, Ludwig-Maximilians University, Munich Heinrich-Heine-University, Dusseldorf, Germany
- Venue
- Neurosurgery
- Published
- 1998-03-01
- Volume
- 42
- Issue
- 3
- Pages
- 518-526
- ISSN
- 0148-396X (ISSN-L)
- 1524-4040
- OpenAlex
- W2070725664
- Cited by
- 690
- References
- 1
- Citations by year
- 2026: 15 · 2025: 22 · 2024: 26 · 2023: 40 · 2022: 36 · 2021: 35 · 2020: 40 · 2019: 43 · 2018: 40 · 2017: 30 · 2016: 30 · 2015: 31 · 2014: 31 · 2013: 30 · 2012: 32
- FWCI
- 15.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurosurgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Photodynamic Therapy Research Studies
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Porphyrin Metabolism and Disorders
- Keywords
- high-grade glioma, 5-aminolevulinic acid, porphyrin fluorescence, intraoperative tumor detection, fluorescence-guided resection, residual tumor, photobleaching, brain tumor surgery
- MeSH terms
- Aged, Aminolevulinic Acid, Brain Neoplasms, Female, Fluorescence, Fluorometry, Glioma, Humans, Intraoperative Period, Lighting, Magnetic Resonance Imaging, Male, Middle Aged, Porphyrins, Sensitivity and Specificity, Neoplasm, Residual
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