Shinobu Yamada1, Yoshihiro Muragaki2, Takashi Maruyama3, Takashi Komori4, Yoshikazu Okada5. 1. Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Departments of Business Development and Research and Development, Nobelpharma Co., Ltd., Tokyo, Japan. 2. Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: ymuragaki@twmu.ac.jp. 3. Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. 4. Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan; Laboratory of Brain Tumor Pathology, Department of Brain Development and Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan. 5. Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
OBJECTIVE: To evaluate the role of the neurochemical navigation with 5-aminolevulinic acid (5-ALA) during intraoperative MRI (iMRI)-guided resection of the intracranial malignant gliomas. METHODS: The analysis included 99 consecutive surgical cases. Resection of the bulk of the neoplasm was mainly guided by the updated neuronavigation based on the low-field-strength (0.3T) iMRI, whereas at the periphery of the lesion neurochemical navigation with 5-ALA was additionally used. RESULTS: In total, 286 tissue specimens were obtained during surgeries for histopathological examination. According to iMRI 98 samples with strong (91 cases), weak (6 cases), or absent (1 case) fluorescence corresponded to the bulk of the lesion and all of those ones contained tumor. Out of 188 tissue specimens obtained from the "peritumoral brain," the neoplastic elements were identified in 89%, 81% and 29% of samples with, respectively, strong (107 cases), weak (47 cases) and absent (34 cases) fluorescence. Positive predictive values of the tissue fluorescence for presence of neoplasm within and outside of its boundaries on iMRI were 100% and 86%, respectively. CONCLUSION: Neurochemical navigation with 5-ALA is useful adjunct during iMRI-guided resection of intracranial malignant gliomas, which allows identification of the tumor extension beyond its radiological borders.
OBJECTIVE: To evaluate the role of the neurochemical navigation with 5-aminolevulinic acid (5-ALA) during intraoperative MRI (iMRI)-guided resection of the intracranial malignant gliomas. METHODS: The analysis included 99 consecutive surgical cases. Resection of the bulk of the neoplasm was mainly guided by the updated neuronavigation based on the low-field-strength (0.3T) iMRI, whereas at the periphery of the lesion neurochemical navigation with 5-ALA was additionally used. RESULTS: In total, 286 tissue specimens were obtained during surgeries for histopathological examination. According to iMRI 98 samples with strong (91 cases), weak (6 cases), or absent (1 case) fluorescence corresponded to the bulk of the lesion and all of those ones contained tumor. Out of 188 tissue specimens obtained from the "peritumoral brain," the neoplastic elements were identified in 89%, 81% and 29% of samples with, respectively, strong (107 cases), weak (47 cases) and absent (34 cases) fluorescence. Positive predictive values of the tissue fluorescence for presence of neoplasm within and outside of its boundaries on iMRI were 100% and 86%, respectively. CONCLUSION: Neurochemical navigation with 5-ALA is useful adjunct during iMRI-guided resection of intracranial malignant gliomas, which allows identification of the tumor extension beyond its radiological borders.
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