5-ALA in Suspected Low-Grade Gliomas: Current Role, Limitations, and New Approaches.

Autor:	Kiesel B; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria., Freund J; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria., Reichert D; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.; Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Vienna, Austria., Wadiura L; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria., Erkkilae MT; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria., Woehrer A; Department of Neurology, Institute for Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria., Hervey-Jumper S; Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, United States., Berger MS; Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, United States., Widhalm G; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2021 Jul 30; Vol. 11, pp. 699301. Date of Electronic Publication: 2021 Jul 30 (Print Publication: 2021).
DOI:	10.3389/fonc.2021.699301
Abstrakt:	Radiologically suspected low-grade gliomas (LGG) represent a special challenge for the neurosurgeon during surgery due to their histopathological heterogeneity and indefinite tumor margin. Therefore, new techniques are required to overcome these current surgical drawbacks. Intraoperative visualization of brain tumors with assistance of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence is one of the major advancements in the neurosurgical field in the last decades. Initially, this technique was exclusively applied for fluorescence-guided surgery of high-grade glioma (HGG). In the last years, the use of 5-ALA was also extended to other indications such as radiologically suspected LGG. Here, we discuss the current role of 5-ALA for intraoperative visualization of focal malignant transformation within suspected LGG. Furthermore, we discuss the current limitations of the 5-ALA technology in pure LGG which usually cannot be visualized by visible fluorescence. Finally, we introduce new approaches based on fluorescence technology for improved detection of pure LGG tissue such as spectroscopic PpIX quantification fluorescence lifetime imaging of PpIX and confocal microscopy to optimize surgery. Competing Interests: JF receives financial research support by NX Development Corp. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Kiesel, Freund, Reichert, Wadiura, Erkkilae, Woehrer, Hervey-Jumper, Berger and Widhalm.)
Databáze:	MEDLINE
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