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5-Aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study

  • Clinical Article
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Abstract

Background

Microsurgical, circumferential stripping of intracerebral metastases often proves to be insufficient to prevent local tumor recurrence.

Objective

We were interested in the potential impact of 5-aminolevulinic acid (5-ALA)-induced-fluorescence (5-AIF) as a diagnostic tool for the resection of intracerebral metastases.

Methods

A retrospective analysis was performed for 52 patients who underwent 5-AIF-guided resection for intracerebral mass lesions that histologically corresponded to metastases from tumors outside the central nervous system. The presence of ALA fluorescence in the tumor was determined in each patient. In 42 patients, fluorescence of the resection cavity after tumor removal was additionally recorded. Data were correlated with neuropathological findings in tissue specimens.

Results

A total of 32 of the 52 metastases (62%) exhibited 5-AIF in tumor parts. All 5-AIF-positive metastases exhibited an inhomogeneous fluorescence pattern. 5-AIF was neither associated with the histological type nor with the site of origin of the metastases. Residual fluorescence of the resection cavity was detected after macroscopically complete white light resection in 24 patients with 5-AIF positive metastases. Residual tumor tissue was histologically confirmed in 6 of 18 patients with available tissue specimens from such 5-AIF positive areas (33%).

Conclusions

The majority of metastases (62%) were 5-AIF positive, suggesting a potential impact of 5-AIF for improved visualization of metastatic tumor tissue within the brain. However, residual 5-AIF after macroscopically complete resection of a metastasis needs to be interpreted with caution because of the limited specificity for detection of residual tumor tissue.

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Conflicts of interest

All authors report no conflict of interest.

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Authors and Affiliations

  1. Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, Geb. 13.71, 40225, Düsseldorf, Germany

    Marcel A. Kamp, Philipp Grosser, Philipp J. Slotty, Hans-Jakob Steiger & Michael Sabel

  2. Institut für Neuropathologie, Heinrich-Heine-Universität, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany

    Jörg Felsberg & Guido Reifenberger

Authors
  1. Marcel A. Kamp
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  2. Philipp Grosser
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  3. Jörg Felsberg
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  4. Philipp J. Slotty
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  5. Hans-Jakob Steiger
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  6. Guido Reifenberger
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  7. Michael Sabel
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Corresponding author

Correspondence to Marcel A. Kamp.

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Comment

5-Aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study

At the authors’ institute, a total of 471 patients underwent open 5-ALA-guided resection for intracerebral lesions preoperatively considered as high-grade gliomas. It turned out that 52 lesions were actually intracerebral metastases, an unexpected research window. Of the 52 metastases, 32 (62%) exhibited 5-ALA-fluorescence, not associated with the histological type or site of origin of the metastases. Furthermore, in 24 (75%) of the 32 fluorescent metastases, there was recidual fluorescence in the cavity wall after seemingly complete removal under white light, confirmed histologically in 6 of the 18 patients with tissue specimens from fluorescent areas in the cavity wall.

This is an important pilot study, awaiting verification by others. Most importantly, these data support the view that many metastases infiltrate the edematous/gliotic brain around them and therefore require more drastic measures than microsurgical removal in white light only.

Juha E Jääskeläinen

Kuopio, Finland

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Kamp, M.A., Grosser, P., Felsberg, J. et al. 5-Aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study. Acta Neurochir 154, 223–228 (2012). https://doi.org/10.1007/s00701-011-1200-5

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  • DOI: https://doi.org/10.1007/s00701-011-1200-5

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