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

Overview

Journal Front Oncol

Specialty Oncology

Date 2021 Aug 16

PMID 34395266

Citations 24

Authors

Barbara Kiesel

Julia Freund

David Reichert

Lisa Wadiura

Mikael T Erkkilae

Adelheid Woehrer

Shawn Hervey-Jumper

Mitchel S Berger

Georg Widhalm

Affiliations

Soon will be listed here.

Abstract

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.

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