The Evolution of 5-Aminolevulinic Acid Fluorescence Visualization: Time for a Headlamp/Loupe Combination

Area of Science:

• Neurosurgery
• Oncology
• Medical Imaging

Background:

• 5-aminolevulinic acid (5-ALA) enhances tumor visualization in malignant glioma resection.
• Current methods use microscope-integrated filters, which have limitations like cost and poor anatomical visualization.
• Improved fluorescence imaging can increase resection extent and progression-free survival.

Purpose of the Study:

• To evaluate low-cost, commercially available devices for 5-ALA fluorescence visualization during glioma surgery.
• To confirm that tumor fluorescence can be detected without specialized operating microscope equipment.
• To document the use of the Designs for Vision REVEAL Fluorescence-Guided Surgery (FGS) system.

Main Methods:

• Three intraoperative cases of high-grade glioma resection were analyzed.
• Fluorescence visualization was performed using a blue light flashlight, a headlamp, and the REVEAL FGS system.
• Comparison of fluorescence visibility across different devices and the standard operating microscope.

Main Results:

• Visible tumor fluorescence was achieved with all tested devices, including low-cost options.
• Adjacent brain structures and vasculature were simultaneously visualized in real-time.
• The REVEAL FGS system demonstrated superior fluorescence emission compared to other methods and the microscope.

Conclusions:

• Inexpensive blue/ultraviolet light devices (flashlights, headlamps) are feasible for visualizing 5-ALA fluorescence in high-grade gliomas.
• The REVEAL FGS system offers a promising new option for fluorescence-guided surgery.
• The absence of a specialized microscope should not impede fluorescence-guided glioma resection.