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Use of 5-ALA fluorescence guided endoscopic biopsy of a deep-seated primary malignant brain tumor
Rainer Ritz1, Guenther C Feigl, Martin U Schuhmann
1Department of Neurosurgery, University of Tübingen Medical Center, Tübingen, Germany. rainer_ritz@hotmail.com
Abstract:
The introduction of fluorescence-guided resection of primary malignant brain tumors was a milestone in neurosurgery. Deep-seated malignant brain tumors are often not approachable for microsurgical resection. For diagnosis and therapy, new strategies are recommended. The combination of endoscopy and 5-aminolevulinic acid-induced protoporphyrin IX (5-ALA-induced Pp IX) fluorescence-guided procedures supported by neuronavigation seems an interesting option. Here the authors report on a combined approach for 5-ALA fluorescence-guided biopsy in which they use an endoscopy system based on an Xe lamp (excitation approximately λ = 407 nm; dichroic filter system λ = 380-430 nm) to treat a malignant tumor of the thalamus and perform a ventriculostomy and septostomy. The excitation filter and emission filter are adapted to ensure that the remaining visible blue remission is sufficient to superimpose on or suppress the excited red fluorescence of the endogenous fluorochromes. The authors report that the lesion was easily detectable in the fluorescence mode and that biopsy led to histological diagnosis.
Insights
This study introduces a novel endoscopic approach using 5-aminolevulinic acid (5-ALA) fluorescence for deep-seated brain tumor biopsies. This technique enhances tumor visualization, enabling accurate diagnosis and treatment of challenging malignant brain tumors.
Area of Science:
- Neurosurgery
- Medical Optics
- Oncology
Background:
- Deep-seated malignant brain tumors present challenges for microsurgical resection.
- Novel diagnostic and therapeutic strategies are crucial for improving patient outcomes.
- Fluorescence-guided surgery, particularly with 5-aminolevulinic acid (5-ALA), has emerged as a promising advancement.
Observation:
- A combined endoscopic and 5-ALA fluorescence-guided approach was utilized for biopsy of a malignant thalamic tumor.
- The system employed an Xe lamp with specific excitation and dichroic filter settings (excitation ~407 nm, dichroic filter 380-430 nm).
- Filters were adjusted to balance blue remission with red fluorescence from endogenous fluorochromes for enhanced visualization.
Findings:
- The malignant tumor was readily detectable using the fluorescence-guided endoscopy system.
- The procedure facilitated a successful biopsy, leading to a definitive histological diagnosis.
- The combined approach allowed for simultaneous ventriculostomy and septostomy.
Implications:
- This technique offers a viable option for diagnosing and potentially treating deep-seated malignant brain tumors previously inaccessible to standard resection.
- Endoscopic fluorescence guidance can improve the accuracy and safety of biopsies in challenging neurosurgical cases.
- Further research may explore the broader application of this combined approach in neuro-oncology.
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