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International Journal of Biomedical Imaging
Volume 2016, Article ID 6135293, 11 pages
Research Article

Fluorescence-Guided Resection of Malignant Glioma with 5-ALA

1Department of Neurosurgery, Tomakomai City Hospital, No. 5-20, 1-chome, Shimizutyou, Tomakomai, Hokkaido 053-0034, Japan
2Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, No. 7-20, 15-chome, 1-jyou, Tsukisamuhigashi, Toyohira-ku, Sapporo, Hokkaido 062-5813, Japan

Received 17 February 2016; Revised 31 May 2016; Accepted 1 June 2016

Academic Editor: Yantian Zhang

Copyright © 2016 Sadahiro Kaneko and Sadao Kaneko. 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.


Malignant gliomas are extremely difficult to treat with no specific curative treatment. On the other hand, photodynamic medicine represents a promising technique for neurosurgeons in the treatment of malignant glioma. The resection rate of malignant glioma has increased from 40% to 80% owing to 5-aminolevulinic acid-photodynamic diagnosis (ALA-PDD). Furthermore, ALA is very useful because it has no serious complications. Based on previous research, it is apparent that protoporphyrin IX (PpIX) accumulates abundantly in malignant glioma tissues after ALA administration. Moreover, it is evident that the mechanism underlying PpIX accumulation in malignant glioma tissues involves an abnormality in porphyrin-heme metabolism, specifically decreased ferrochelatase enzyme activity. During resection surgery, the macroscopic fluorescence of PpIX to the naked eye is more sensitive than magnetic resonance imaging, and the alert real time spectrum of PpIX is the most sensitive method. In the future, chemotherapy with new anticancer agents, immunotherapy, and new methods of radiotherapy and gene therapy will be developed; however, ALA will play a key role in malignant glioma treatment before the development of these new treatments. In this paper, we provide an overview and present the results of our clinical research on ALA-PDD.