Brain Tumor Res Treat.  2019 Oct;7(2):98-104. 10.14791/btrt.2019.7.e38.

Experience Profiling of Fluorescence-Guided Surgery I: Gliomas

• Ji SY
• Kim JW
• Park CK

• KMID: 2461182
• DOI: http://doi.org/10.14791/btrt.2019.7.e38

Abstract

BACKGROUND
Numerous studies reported a usefulness of 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery (FGS) in high grade gliomas. However, fluorescence patterns and intensities are variable among gliomas. In this study, we report our extensive experience with FGS in various gliomas, focusing on epidemiological data of fluorescence patterns.
METHODS
A total of 827 histologically proven glioma patients out of 900 brain tumor patients who had undergone FGS using 5-ALA during the period of 8.5 years between July 2010 and January 2019 were analyzed. Indications of FGS in glioma surgery are evidence for possible high-grade foci in putative gliomas in preoperative MRI.
RESULTS
Among the 827 gliomas, the number of cases corresponding to 2016 World Health Organization (WHO) grade IV, III, II, and I are 528 (58.7%), 193 (21.4%), 87 (9.7%) and 19 (2.1%), respectively. In terms of fluorescence rate, grade IV gliomas showed positive fluorescence in 95.4% of cases including strong intensity in 85.6%. Grade III gliomas showed fluorescence in about half of cases (55.0%), but 45.0% of the cases showed no fluorescence at all. Anaplastic oligodendroglioma had a higher positive rate (63.9%) than anaplastic astrocytoma (46.2%). Both grade II and I gliomas still showed positive fluorescence in about one-fourth of cases (24.1% and 26.3% respectively). Among them ependymoma and pilocytic astrocytoma were fluorescence-prone tumors.
CONCLUSION
This epidemiological data of 5-ALA fluorescence in various grades of glioma provides a basic reference to the clinical application of FGS with 5-ALA in glioma surgery.

Keyword

Fluorescence; Gliomas; Glioblastoma; Surgery

MeSH Terms

Astrocytoma
Brain Neoplasms
Ependymoma
Fluorescence
Glioblastoma
Glioma*
Humans
Magnetic Resonance Imaging
Oligodendroglioma
World Health Organization

Figure

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  Fig. 1 A: Distribution of histological diagnosis of 900 fluorescence-guided surgery cases including 827 gliomas. Experience of other 73 non-glioma cases (gray text) are described in the other paper in this issue (Experience profiling of fluorescence-guided surgery II: non-glioma pathologies). Numbers in diagram indicate number of cases. B: Distribution of fluorescence intensity of 827 gliomas classified by World Health Organization (WHO) grade. GBM, glioblastoma; AA, anaplastic astrocytoma; AO, anaplastic oligodendroglioma; AE, anaplastic ependymoma; ODG, oligodendroglioma; A, astrocytoma; EPN, ependymoma; PXA, pleomorphic xanthoastrocytoma; Gr, grade. Tx: treatment, SFT: solitary fibrous tumor, HPC: hemangiopericytoma.

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  Fig. 2 A: Distribution of fluorescence intensity and complete resection rate of World Health Organization (WHO) grade IV gliomas. Numbers in glioblastoma indicate number of cases, while a single cubic unit in gliosarcoma and diffuse midline glioma denotes individual case. B: Radiological characteristics of 20 glioblastoma cases which showed no fluorescence. Among them, 5 cases showed no enhancement (NE) and represented with T2-weighted MRIs, and the other 15 cases showed strong enhancement in T1-weighted MRIs.

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  Fig. 3 Distribution of fluorescence intensity and complete resection rate of World Health Organization (WHO) grade III gliomas. Numbers in anaplastic astrocytoma and anaplastic oligodendroglioma indicate number of cases, while a single cubic unit in anaplastic ependymoma and anaplastic ganglioglioma denotes individual case.

• 

  Fig. 4 Distribution of fluorescence intensity and complete resection rate of World Health Organization (WHO) grade II and I gliomas. Numbers in oligodendroglioma indicate number of cases, while a single cubic unit in other tumors denotes individual case.

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