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5-ALA fluorescence-guided resection of pediatric low-grade glioma using the ORBEYE 3D digital exoscope: a technical report

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Abstract

Objective

A case of low-grade glioma in which 5-aminolevulinic acid (5-ALA) fluorescence was visualized by a digital exoscope is presented.

Case presentation

A 14-year-old girl with recurrent paroxysmal episodes of a strange smell and nausea underwent magnetic resonance imaging (MRI) for further investigation. The MRI showed a tumor with an enhanced nodule in the right temporal lobe. The patient received 5-ALA preoperatively, and intraoperative observation using a 4 K-3-dimension digital exoscope (Olympus ORBEYE) showed that the tumor was fluorescent, which was useful in determining the extent of tumor removal. Postoperative MRI showed that the tumor was completely removed. The histopathological diagnosis was pleomorphic xanthoastrocytoma. She was discharged without any complications.

Conclusions

5-ALA-fluorescence-guided resection of low-grade glioma using the ORBEYE was useful for determining the extent of removal.

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Availability of data and material

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

5-ALA:

5-Aminolevulinic acid

MRI:

Magnetic resonance imaging

Gd:

Gadolinium

GFAP:

Glial fibrillary acidic protein

PpIX:

Protoporphyrin IX

References

  1. Roth J, Constantini S (2017) 5ALA in pediatric brain tumors is not routinely beneficial. Childs Nerv Syst 33:787–792. https://doi.org/10.1007/s00381-017-3371-8

    Article  PubMed  Google Scholar 

  2. Stummer W, Rodrigues F, Schucht P, Preuss M, Wiewrodt D, Nestler U, Stein M, Artero JM, Platania N, Skjoth-Rasmussen J, Della Puppa A, Caird J, Cortnum S, Eljamel S, Ewald C, Gonzalez-Garcia L, Martin AJ, Melada A, Peraud A, Brentrup A, Santarius T, Steiner HH, European ALAPBTSG (2014) Predicting the “usefulness” of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey. Acta Neurochir (Wien) 156:2315–2324. https://doi.org/10.1007/s00701-014-2234-2

    Article  PubMed  Google Scholar 

  3. Vogelbaum MA, Kroll D, Etame A, Tran N, Liu J, Ford A, Sparr E, Kim Y, Forsyth P, Sahebjam S, Mokhtari S, Peguero E, Macaulay R (2021) A prospective validation study of the first 3D digital exoscope for visualization of 5-ALA-induced fluorescence in high-grade gliomas. World Neurosurg 149:e498–e503. https://doi.org/10.1016/j.wneu.2021.01.147

    Article  PubMed  Google Scholar 

  4. Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ (2000) Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg 93:1003–1013. https://doi.org/10.3171/jns.2000.93.6.1003

    Article  CAS  PubMed  Google Scholar 

  5. Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, Group AL-GS (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401. https://doi.org/10.1016/S1470-2045(06)70665-9

    Article  CAS  Google Scholar 

  6. Beez T, Sarikaya-Seiwert S, Steiger HJ, Hanggi D (2014) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of brain tumors in children–a technical report. Acta Neurochir (Wien) 156:597–604. https://doi.org/10.1007/s00701-014-1997-9

    Article  PubMed  Google Scholar 

  7. Goryaynov SA, Okhlopkov VA, Golbin DA, Chernyshov KA, Svistov DV, Martynov BV, Kim AV, Byvaltsev VA, Pavlova GV, Batalov A, Konovalov NA, Zelenkov PV, Loschenov VB, Potapov AA (2019) Fluorescence diagnosis in neurooncology: retrospective analysis of 653 cases. Front Oncol 9:830. https://doi.org/10.3389/fonc.2019.00830

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ruge JR, Liu J (2009) Use of 5-aminolevulinic acid for visualization and resection of a benign pediatric brain tumor. J Neurosurg Pediatr 4:484–486. https://doi.org/10.3171/2009.6.PEDS08428

    Article  PubMed  Google Scholar 

  9. Schwake M, Kaneko S, Suero Molina E, Muther M, Schipmann S, Kochling M, Brentrup A, Stummer W (2019) Spectroscopic measurement of 5-ALA-induced intracellular protoporphyrin IX in pediatric brain tumors. Acta Neurochir (Wien) 161:2099–2105. https://doi.org/10.1007/s00701-019-04039-4

    Article  PubMed  Google Scholar 

  10. Wisoff JH, Sanford RA, Heier LA, Sposto R, Burger PC, Yates AJ, Holmes EJ, Kun LE (2011) Primary neurosurgery for pediatric low-grade gliomas: a prospective multi-institutional study from the Children's Oncology Group. Neurosurgery discussion 68:1554–1545. https://doi.org/10.1227/NEU.0b013e318214a66e

  11. Murai Y, Sato S, Yui K, Morimoto D, Ozeki T, Yamaguchi M, Tateyama K, Nozaki T, Tahara S, Yamaguchi F, Morita A (2019) Preliminary clinical microneurosurgical experience with the 4K3-dimensional microvideoscope (ORBEYE) system for microneurological surgery: observation study. Oper Neurosurg (Hagerstown) 16:707–716. https://doi.org/10.1093/ons/opy277

    Article  PubMed  Google Scholar 

  12. Stummer W, Reulen HJ, Novotny A, Stepp H, Tonn JC (2003) Fluorescence-guided resections of malignant gliomas–an overview. Acta Neurochir Suppl 88:9–12. https://doi.org/10.1007/978-3-7091-6090-9_3

    Article  CAS  PubMed  Google Scholar 

  13. Traylor JI, Pernik MN, Sternisha AC, McBrayer SK, Abdullah KG (2021) Molecular and metabolic mechanisms underlying selective 5-aminolevulinic acid-induced fluorescence in gliomas. Cancers (Basel). https://doi.org/10.3390/cancers13030580

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan

    Masatomo Maeda, Masahiro Nonaka, Nobuaki Naito, Katsuya Ueno, Takamasa Kamei & Akio Asai

Authors
  1. Masatomo Maeda
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  2. Masahiro Nonaka
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  3. Nobuaki Naito
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  4. Katsuya Ueno
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  5. Takamasa Kamei
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  6. Akio Asai
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Contributions

Masatomo Maeda: acquisition of data, drafting the manuscript. Masahiro Nonaka: conception and design of the study, acquisition of data, analysis and/or interpretation of data, revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published. Nobuaki Naito: revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published. Katsuya Ueno: revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published. Takamasa Kamei: revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published. Akio Asai: revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published.

Corresponding author

Correspondence to Masahiro Nonaka.

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Ethics approval and consent to participate

This study was approved by the Ethics Committee of Kansai Medical University. (No. 2018037). Written informed consent was obtained from the patient’s legal guardians.

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The participant has consented to the submission of the report to the journal.

Conflict of interest

The authors declare no competing interests.

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Maeda, M., Nonaka, M., Naito, N. et al. 5-ALA fluorescence-guided resection of pediatric low-grade glioma using the ORBEYE 3D digital exoscope: a technical report. Childs Nerv Syst 39, 1061–1064 (2023). https://doi.org/10.1007/s00381-022-05612-6

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  • DOI: https://doi.org/10.1007/s00381-022-05612-6

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