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5-ALA fluorescence–guided surgery in pediatric brain tumors—a systematic review

  • Review Article - Pediatric Neurosurgery
  • Published:
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Abstract

Background

5-Aminolevulinic acid (5-ALA)-guided resection of gliomas in adults enables better differentiation between tumor and normal brain tissue, allowing a higher degree of resection, and improves patient outcomes. In recent years, several reports have emerged regarding the use of 5-ALA in other brain tumor entities, including pediatric brains tumors. Since gross total resection (GTR) of many brain tumors in children is crucial and the role of 5-ALA-guided resection of these tumors is not clear, we sought to perform a comprehensive literature review on this topic.

Methods

A systematic literature review of EMBASE and MEDLINE/PubMed databases revealed 19 eligible publications encompassing 175 5-ALA-guided operations on pediatric brain tumors. To prevent bias, publications were revised independently by two authors.

Results

We found that 5-ALA-guided resection enabled the surgeons to identify the tumor more easily and was considered helpful mainly in cases of glioblastoma (GBM, 21/27, 78%), anaplastic ependymoma WHO grade III (10/14, 71%), and anaplastic astrocytoma (4/6, 67%). In contrast, cases of pilocytic astrocytomas (PAs) and medulloblastomas 5-ALA-guided surgery did not show consistent fluorescent signals and 5-ALA was considered helpful only in 12% and 22% of cases, respectively. Accumulation of fluorescent porphyrins seems to depend on WHO tumor grading. One important finding is that when 5-ALA-guided resections were considered helpful, the degree of resection was higher than is cases where it was not helpful. The rate of adverse events related to 5-ALA was negligible, especially new postoperative sequelae.

Conclusion

5-ALA could play a role in resection of pediatric brain tumors. However, further prospective clinical trials are needed.

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  1. Department of Neurosurgery, University Hospital Münster, Germany Albert-Schweitzer-Campus 1, Building A1, 48149, Munster, Germany

    Michael Schwake, Stephanie Schipmann, Michael Müther, Michaela Köchling, Angela Brentrup & Walter Stummer

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  1. Michael Schwake
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Correspondence to Michael Schwake.

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Walter Stummer has received consultant fees from Medac, Wedel, Germany. All other authors declare that they have no conflict of interest.

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Schwake, M., Schipmann, S., Müther, M. et al. 5-ALA fluorescence–guided surgery in pediatric brain tumors—a systematic review. Acta Neurochir 161, 1099–1108 (2019). https://doi.org/10.1007/s00701-019-03898-1

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