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BioMed Research International
Volume 2014 (2014), Article ID 232561, 8 pages
http://dx.doi.org/10.1155/2014/232561
Clinical Study

5-Aminolevulinic Acid Fluorescence in High Grade Glioma Surgery: Surgical Outcome, Intraoperative Findings, and Fluorescence Patterns

1Department of Neurosurgery, Padua University Hospital, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy
2Department of Oncology, IOV IRCCS Oncology Institute of Padua, Via Gattamelata 64, 35128 Padova, Italy
3Neuroradiology Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128 Padova, Italy
4Department of Medicine (DIMED), Nuclear Medicine Service, University of Padua, Via Giustiniani 2, 35128 Padova, Italy

Received 11 February 2014; Accepted 10 March 2014; Published 8 April 2014

Academic Editor: Anna Luisa Di Stefano

Copyright © 2014 Alessandro Della Puppa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. 5-Aminolevulinic acid (5-ALA) fluorescence is a validated technique for resection of high grade gliomas (HGG); the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients. Methods. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection % and %. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO). Results. 94 patients were finally enrolled. Overall % and % was achieved in 93% and 100% of patients. Extent of resection was dependent on tumor location, tumor grade , and tumor size . In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57%) and recurrent (60%) tumors. Conclusions. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.