Matthias Millesi1,2, Barbara Kiesel1,2, Adelheid Wöhrer2,3, Petra A Mercea1,2, Marco Bissolo1,2, Thomas Roetzer2,3, Stefan Wolfsberger1,2, Julia Furtner2,4, Engelbert Knosp1,2, Georg Widhalm1,2. 1. Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. 2. Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria. 3. Institute of Neurology, Medical University of Vienna, Vienna, Austria. 4. Department of Biomedical Imaging and image-guided Therapy, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: Intraoperative histopathology and acquisition of multiple tissue samples in stereotactic biopsies results in a prolonged length of surgery and potentially increased complication rate. OBJECTIVE: To investigate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with the assistance of 5-aminolevulinic acid (5-ALA) induced fluorescence. METHODS: Patients that received 5-ALA prior to stereotactic biopsy of a suspected brain tumor were included. According to our strategy, the procedure was terminated in the case of strong fluorescence of the biopsy samples. In contrast, intraoperative histology was demanded in the case of vague/no fluorescence. Length of surgery, number of biopsy samples, diagnostic rate, and periprocedural complications were compared between these 2 groups. RESULTS: Altogether, 79 patients were included, and strong fluorescence was present in 62 cases (79%), vague fluorescence was in 4 cases (5%), and no fluorescence was in 13 cases (16%). The diagnostic rate was comparable in biopsies with strong fluorescence without intraoperative histopathology and cases with vague/no fluorescence with intraoperative histopathology (98% vs 100%; P = 1.000). A significantly shorter length of surgery (41 vs 77 min; P < .001) and reduced average number of biopsy samples (3.6 vs 4.9; P = .011) was found in patients with strong compared to vague/no fluorescence. However, no statically significant difference in periprocedural complications between cases with strong and vague/no fluorescence was found (7% vs 18%; P = .166). CONCLUSION: Our data demonstrate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with assistance of 5-ALA. Thus, this biopsy strategy will increase the efficiency of this standard neurosurgical procedure in the future.
BACKGROUND: Intraoperative histopathology and acquisition of multiple tissue samples in stereotactic biopsies results in a prolonged length of surgery and potentially increased complication rate. OBJECTIVE: To investigate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with the assistance of 5-aminolevulinic acid (5-ALA) induced fluorescence. METHODS:Patients that received 5-ALA prior to stereotactic biopsy of a suspected brain tumor were included. According to our strategy, the procedure was terminated in the case of strong fluorescence of the biopsy samples. In contrast, intraoperative histology was demanded in the case of vague/no fluorescence. Length of surgery, number of biopsy samples, diagnostic rate, and periprocedural complications were compared between these 2 groups. RESULTS: Altogether, 79 patients were included, and strong fluorescence was present in 62 cases (79%), vague fluorescence was in 4 cases (5%), and no fluorescence was in 13 cases (16%). The diagnostic rate was comparable in biopsies with strong fluorescence without intraoperative histopathology and cases with vague/no fluorescence with intraoperative histopathology (98% vs 100%; P = 1.000). A significantly shorter length of surgery (41 vs 77 min; P < .001) and reduced average number of biopsy samples (3.6 vs 4.9; P = .011) was found in patients with strong compared to vague/no fluorescence. However, no statically significant difference in periprocedural complications between cases with strong and vague/no fluorescence was found (7% vs 18%; P = .166). CONCLUSION: Our data demonstrate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with assistance of 5-ALA. Thus, this biopsy strategy will increase the efficiency of this standard neurosurgical procedure in the future.
Authors: Michael Weller; Martin van den Bent; Matthias Preusser; Emilie Le Rhun; Jörg C Tonn; Giuseppe Minniti; Martin Bendszus; Carmen Balana; Olivier Chinot; Linda Dirven; Pim French; Monika E Hegi; Asgeir S Jakola; Michael Platten; Patrick Roth; Roberta Rudà; Susan Short; Marion Smits; Martin J B Taphoorn; Andreas von Deimling; Manfred Westphal; Riccardo Soffietti; Guido Reifenberger; Wolfgang Wick Journal: Nat Rev Clin Oncol Date: 2020-12-08 Impact factor: 66.675
Authors: Barbara Kiesel; Lisa I Wadiura; Mario Mischkulnig; Jessica Makolli; Veronika Sperl; Martin Borkovec; Julia Freund; Alexandra Lang; Matthias Millesi; Anna S Berghoff; Julia Furtner; Adelheid Woehrer; Georg Widhalm Journal: Cancers (Basel) Date: 2021-12-04 Impact factor: 6.639
Authors: Alexander J Schupper; Manasa Rao; Nicki Mohammadi; Rebecca Baron; John Y K Lee; Francesco Acerbi; Constantinos G Hadjipanayis Journal: Front Neurol Date: 2021-06-16 Impact factor: 4.003