Application of 5-ALA Fluorescence-Guided Resection in Patients Suffering from High-Grade Gliomas: Report of 30 Consecutive Cases and a Literature Review

Background and Importance: The extent of resection seems a solid prognostic factor in patients suffering from high-grade gliomas (HGGs). When administered orally, 5-ALA is exclusively converted by malignant cells into protoporphyrin IX (PPIX), identifying contrast-enhancing glial lesions under blue 400-nm light. The authors thoroughly assess the efficacy, accuracy, and safety profile of 5-ALA-guided surgery toward the maximal resection of cranial HGGs. Case Presentation: Thirty consecutive patients suffering from high-grade gliomas adjacent to the corticospinal tract (CST) met our inclusion criteria in a single-arm retrospective study. Bilateral diffusion tensor imaging (DTI)-derived CST tractography was employed in aid of a 1.5 Tesla MRI. Oral 5-ALA was ingested with a dose of 20mg/kg 4 hours prior to operation and was applied to qualify the margins of the local resection cavity. The clinical and volumetric assessments were postoperatively conducted. The mean preoperative tumor volume on T1 contrast-enhanced MR and FLAIR images was 16.8 cm3 and 47.6cm3, respectively. Complete resection of contrast-enhanced lesions was yielded in 27 of all 30 suffers (90%). All patients improved postoperatively regarding motor deficits and/or seizures. No new permanent neurological deficits were detected in 3 months follow-up. Conclusion: FIGS using 5-ALA increases the EOR with further surgical risks in eloquent regions when combined with multimodality visualization- functional mapping. It also provides pathological insights to visualize cranial HGGs and identify infiltration of functional fiber tracts.