Experience Profiling of Fluorescence-Guided Surgery I: Gliomas

Area of Science:

• Neurosurgery
• Oncology
• Medical Imaging

Background:

• 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery (FGS) is recognized for its utility in high-grade gliomas.
• Fluorescence patterns and intensities can vary significantly among different glioma types.
• This study investigates extensive clinical experience with FGS in various gliomas, focusing on fluorescence pattern epidemiology.

Purpose of the Study:

• To analyze epidemiological data of 5-aminolevulinic acid (5-ALA) fluorescence patterns in a large cohort of glioma patients.
• To establish a reference for the clinical application of 5-ALA FGS in glioma surgery based on fluorescence characteristics.
• To correlate fluorescence rates and intensities with different World Health Organization (WHO) grades of gliomas.

Main Methods:

• Analysis of 827 histologically confirmed glioma patients who underwent 5-ALA FGS between July 2010 and January 2019.
• Inclusion criteria: patients with preoperative MRI evidence of possible high-grade glioma foci.
• Data collection focused on fluorescence patterns and intensity across various glioma grades.

Main Results:

• WHO grade IV gliomas (58.7%) exhibited 95.4% positive fluorescence, with 85.6% showing strong intensity.
• Grade III gliomas showed 55.0% positive fluorescence, while grade II and I gliomas had approximately 24-26% positive fluorescence.
• Anaplastic oligodendroglioma had a higher positive fluorescence rate (63.9%) than anaplastic astrocytoma (46.2%); ependymoma and pilocytic astrocytoma were fluorescence-prone.

Conclusions:

• The epidemiological data on 5-ALA fluorescence in gliomas provides a foundational reference for clinical practice.
• Understanding fluorescence variability is crucial for optimizing FGS in glioma surgery.
• This study supports the continued application and refinement of 5-ALA FGS in neuro-oncology.