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5-Aminolevulinic Acid–Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 43))

Abstract

The current first-line treatment of malignant gliomas consists in surgical resection (if possible) as large as possible. The existing tools don’t permit to identify the limits of tumor infiltration, which goes beyond the zone of contrast enhancement on MRI. The fluorescence-guided malignant gliomas surgery was started 15 years ago and had become a standard of care in many countries. The technique is based on fluorescent molecule revelation using the filters, positioned within the surgical microscope. The fluorophore, protoporphyrin IX (PpIX), is converted in tumoral cells from 5-aminolevulinic acid (5-ALA), given orally before surgery. Many studies have shown that the ratio of gross total resections was higher if the fluorescence technique was used. The fluorescence signal intensity is correlated to the cell density and the PpIX concentration. The current method has a very high specificity but still lower sensibility, particularly regarding the zones with poor tumoral infiltration. This book reviews the principles of the technique and the results (extent of resection and survival).

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Hospital, Lyon, France

    Jacques Guyotat MD, PhD & Vladislav Pavlov MD

  2. Department of Neurosurgery, Sainte Anne Hospital, Paris, France

    Johan Pallud MD, PhD

  3. Paris Descartes University, Paris, France

    Johan Pallud MD, PhD

  4. Délégation à la recherche clinique et à l’innovation, cellule innovation Hospices Civils de, Lyon, France

    Xavier Armoiry PharmD, PhD

  5. Department of Neurosurgery, Timone Hospital, Marseille, France

    Philippe Metellus MD, PhD

  6. University Aix Marseille, Marseille, France

    Philippe Metellus MD, PhD

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  1. Jacques Guyotat MD, PhD
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  2. Johan Pallud MD, PhD
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  3. Xavier Armoiry PharmD, PhD
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  4. Vladislav Pavlov MD
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  5. Philippe Metellus MD, PhD
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Correspondence to Jacques Guyotat MD, PhD .

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  1. Medical Faculty, Universtiy of Bonn, Bonn, Germany

    Johannes Schramm

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Guyotat, J., Pallud, J., Armoiry, X., Pavlov, V., Metellus, P. (2016). 5-Aminolevulinic Acid–Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review. In: Schramm, J. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 43. Springer, Cham. https://doi.org/10.1007/978-3-319-21359-0_3

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