With a little help from my friends: The role of intraoperative fluorescent dyes in the surgical management of high-grade gliomas

Antonio Imperato, Domenico Iacopino, Rosario Maugeri, Francesca Graziano, Alessia Imperato, Carlo Gulì, Mariangela Pino, Alessandro Villa, Gabriele Costantino, Giuseppe Roberto Giammalva, Domenico Gerardo Iacopino, Natale Francaviglia, Francesco Meli, Giuseppe Roberto Giammalva, Luisa Anna Villa

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)

Abstract

High-grade gliomas (HGGs) are the most frequent primary malignant brain tumors in adults, which lead to death within two years of diagnosis. Maximal safe resection of malignant gliomas as the first step of multimodal therapy is an accepted goal in malignant glioma surgery. Gross total resection has an important role in improving overall survival (OS) and progression-free survival (PFS), but identification of tumor borders is particularly difficult in HGGS. For this reason, imaging adjuncts, such as 5-aminolevulinic acid (5-ALA) or fluorescein sodium (FS) have been proposed as superior strategies for better defining the limits of surgical resection for HGG. 5-aminolevulinic acid (5-ALA) is implicated as precursor in the synthetic pathway of heme group. Protoporphyrin IX (PpIX) is an intermediate compound of heme metabolism, which produces fluorescence when excited by appropriate light wavelength. Malignant glioma cells have the capacity to selectively synthesize or accumulate 5-ALA-derived porphyrins after exogenous administration of 5-ALA. Fluorescein sodium (FS), on the other hand, is a fluorescent substance that is not specific to tumor cells but actually it is a marker for compromised blood-brain barrier (BBB) areas. Its effectiveness is confirmed by multicenter phase-II trial (FLUOGLIO) but lack of randomized phase III trial data. We conducted an analytic review of the literature with the objective of identifying the usefulness of 5-ALA and FS in HGG surgery in adult patients.
Original languageEnglish
Pages (from-to)31-47
Number of pages17
JournalBrain Sciences
Volume8
Publication statusPublished - 2018

All Science Journal Classification (ASJC) codes

  • General Neuroscience

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