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5-Aminolevulinic acid fluorescence in brain non-neoplastic lesions: a systematic review and case series

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Abstract

Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is used to assist brain tumor resection, especially for high-grade gliomas but also for low-grade gliomas, metastasis, and meningiomas. With the increasing use of this technique, even to assist biopsies, high-grade glioma–mimicking lesions had misled diagnosis by showing 5-ALA fluorescence in non-neoplastic lesions such as radiation necrosis and inflammatory or infectious disease. Since only isolated reports have been published, we systematically review papers reporting non-neoplastic lesion cases with 5-ALA according with the PRISMA guidelines, present our series, and discuss its pathophysiology. In total, 245 articles were identified and 12 were extracted according to our inclusion criteria. Analyzing 27 patients, high-grade glioma was postulated as preoperative diagnosis in 48% of the cases. Microsurgical resection was performed in 19 cases (70%), while 8 patients were submitted to biopsy (30%). We found 4 positive cases in demyelinating disease (50%), 4 in brain abscess (80%), 1 in neurocysticercosis (33%), 1 in neurotoxoplasmosis, infarction, and hematoma (100%), 4 in inflammatory disease (80%), and 3 in cortical dysplasia (100%). New indications are being considered especially in benign lesion biopsies with assistance of 5-ALA. Using fluorescence as an aid in biopsies may improve procedure time, number of samples, and necessity of intraoperative pathology. Further studies should include this technology to encourage more beneficial uses.

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Acknowledgements

We thank all the neurosurgical residents for their assistance throughout all aspects of our study.

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute of Curitiba, Jeremias Maciel Perretto 300, 81210-310, Curitiba, Brazil

    Joel F. Sanabria Duarte, Gustavo S. Jung, Erasmo Barros da Silva Jr & Ricardo Ramina

  2. Department of Neuroradiology, Neurological Institute of Curitiba, Curitiba, Brazil

    Bernardo Corrêa de Almeida Teixeira

  3. Department of Neuropathology, Neurological Institute of Curitiba, Curitiba, Brazil

    Marcela Santos Cavalcanti

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  1. Joel F. Sanabria Duarte
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  2. Gustavo S. Jung
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  3. Erasmo Barros da Silva Jr
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  5. Marcela Santos Cavalcanti
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  6. Ricardo Ramina
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Joel Sanabria and Gustavo Jung. Bernardo Correa prepared the MRI images and Marcela Santos the histological images. The first draft of the manuscript was written by Joel Sanabria and all authors commented on previous versions of the manuscript. All authors reviewed and approved the final manuscript.

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Correspondence to Joel F. Sanabria Duarte.

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This research study was conducted retrospectively from data obtained for clinical purposes. The Hospital Research Ethics Committee has confirmed that no ethical approval is required. Informed consent was obtained from all individual participants included in our case series.

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The authors declare no competing interests.

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Duarte, J.F.S., Jung, G.S., da Silva, E.B. et al. 5-Aminolevulinic acid fluorescence in brain non-neoplastic lesions: a systematic review and case series. Neurosurg Rev 45, 3139–3148 (2022). https://doi.org/10.1007/s10143-022-01843-y

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