Child's Nervous System

, Volume 34, Issue 5, pp 971–975 | Cite as

The use of 5-aminolevulinic acid to assist gross total resection of pediatric astroblastoma

  • Yuji Agawa
  • Takafumi Wataya
Case Report



Astroblastoma is an uncommon pediatric neuroepithelial tumor. The prognosis and appropriate treatment of astroblastoma were not well understood. Previous reports suggested the best treatment for astroblastoma is surgical total resection. The authors report a case of pediatric astroblastoma that underwent gross total resection with the use of fluorescent guidance by 5-aminolevulinic acid (5-ALA).

Case report

A 13-year-old girl presented with the tumor that was well-circumscribed cystic and solid mass with marked gadolinium enhancement in the right occipital lobe. At surgery, fluorescence of the tumor was clearly distinctive from the normal cerebral tissue. All fluorescent tissue including residual cyst wall was removed. Postoperative MRI showed gross total resection of the tumor. No serious side effect or complications occurred. The histopathologic diagnosis was suggestive of astroblastoma. The patients had no evidence of recurrence of tumor without adjuvant radiotherapy during the last 1 year of follow-up time.


5-ALA is useful to achieve gross total resection including cystic lesion of pediatric astroblastoma. A larger prospective study is warranted to establish the use of 5-ALA in pediatric brain tumor.


5-aminolevulinic acid Gross total resection Astroblastoma Pediatric 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Agarwal V, Mally R, Palande DA, Velho V (2012) Cerebral astroblastoma: a case report and review literature. Asian J Neurosurg 7(2):98–100. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bailey P, Bucy PC (1930) Astroblastoma of the brain. Acta Psychiatr Neurol 5(3):439–461. CrossRefGoogle Scholar
  3. 3.
    Baka JJ, Patel SC, Roebuck JR, Hearshen DO (1993) Predominantly extraaxial astroblastoma: imaging and proton MR spectroscopy features. AJNR Am J Neuroradiol 14(4):946–950PubMedGoogle Scholar
  4. 4.
    Barbagallo GM, Certo F, Heiss K, Albaness V (2014) 5-ALA fluorescence-assisted surgery in pediatric brain tumors: report of three cases and review of the literature. Br J Neurosurg 28(6):750–754. CrossRefPubMedGoogle Scholar
  5. 5.
    Beez T, Sarikaya-Seiwert S, Steiger HJ, Hänggi D (2014) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of brain tumors in children-a technical report. Acta Neurochir 156(3):597–604. CrossRefPubMedGoogle Scholar
  6. 6.
    Coldotz MJ, Jeffree RL (2012) Aminoleuvulinic acid (ALA)-protoporphyrin IX fluorescence guided tumor resection. Part 1: clinical, radiological and pathological studies. J Clin Neurosci 19(11):1471–1474. CrossRefGoogle Scholar
  7. 7.
    Coldotz MJ, Jeffree RL (2012) Aminoleuvulinic acid (ALA)-protoporphyrin IX fluorescence guided tumor resection. Part 2: theoretical, biochemical and practical aspects. J Clin Neurosci 19(12):1611–1616. CrossRefGoogle Scholar
  8. 8.
    de la Garma VH, Arcipreste AA, Vázquez FP, Aguilar RR, Castruita UO, Guerra RM (2014) High-grade astroblastom in a child: report of one case and review of literature. Surg Neurol Int 5(1):111. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Eicker S, Sarikaya-Seiwert S, Borkhardt A, Gierga K, Turowski B, Heiroth HJ, Steiger HJ, Stummer W (2011) ALA-induced porphyrin accumulation in medulloblastoma and its use for fluorescence-guided surgery. Cen Eur Neurosurg 72(02):101–104. CrossRefGoogle Scholar
  10. 10.
    Janz C, Buhl R (2014) Astroblastoma: report of two cases with unexpected clinical behavior and review of the literature. Clin Neurol Neurosurg 125:114–124. CrossRefPubMedGoogle Scholar
  11. 11.
    Johson KA, Bonnin JM, Boaz JC, Douglas-Akinwande AC, Hattab EM (2010) Anaplastic astroblastoma presenting as massive, sudden-onset, intraparenchymal hemorrhage. Pediatr Neurosurg 46(6):457–461. CrossRefGoogle Scholar
  12. 12.
    Kubota T, Sato K, Arishima H, Takeuchi H, Kitai R, Nakagawa T (2006) Astroblastoma: immunohistochemical and ultrastructural study of distinctive epitherial and probable tanycytic differentiation. Neuropathology 26(1):72–81. CrossRefPubMedGoogle Scholar
  13. 13.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2007) World Health Organization classification of tumours of the central nervous system. IARC Press, LyonsGoogle Scholar
  14. 14.
    Mastrangelo S, Lauriola L, Coccia P, Puma N, Massimi L, Riccardi R (2010) Two cases of pediatric high-grade astroblastoma with different clinical behavior. Tumori 96(1):160–163CrossRefPubMedGoogle Scholar
  15. 15.
    Millesi M, Kiesel B, Mischkulnig M, Martinez-Moreno M, Wöhrer A, Wolfsberger S et al (2016) Analysis of the surgical benefits of 5-ALA-induced fluorescence in intracranial meningiomas: experience in 204 meningiomas. J Neurosurg 125(6):1408–1419. CrossRefPubMedGoogle Scholar
  16. 16.
    Pizer BL, Moss T, Oakhill A, Webb D, Coakham HB (1995) Congenital astroblastoma: an immunohistochemical study: case report. J Neurosurg 83(3):550–555. CrossRefPubMedGoogle Scholar
  17. 17.
    Preuß M, Renner C, Krupp W, Christiansen H, Fischer L, Merkenschlager A, Kieß W, Müller W, Manzo N, Meixensberger J, Nestler U (2013) The use of 5-aminolevulinic acid fluorescence in resection of pediatric tumors. Child Nerv Syst 29(8):1263–1267. CrossRefGoogle Scholar
  18. 18.
    Ruge JP, Liu J (2009) Use of 5-aminolevulinic acid for visualization and resection of benign pediatric tumor. J Neurosurg Pediatr 4(5):484–486. CrossRefPubMedGoogle Scholar
  19. 19.
    Salvati M, D'Elia A, Brogna C, Frati A, Antonelli M, Giangaspero F et al (2009) Cerebral astroblastoma: analysis of six cases and critical review of treatment options. J Neuro-Oncol 93(3):369–378. CrossRefGoogle Scholar
  20. 20.
    Sener RN (2002) Astroblastoma: diffusion MRI, and proton MR spectroscopy. Comput Med Imaging Graph 26(3):187–191. CrossRefPubMedGoogle Scholar
  21. 21.
    Singh DK, Singh N, Sihgh R, Husain N (2014) Cerebral astroblastoma: a radiopathological diagnosis. J Pediatr Neurosci 9(1):45–47. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Skjøth-Rasmussen J, Bøgeskov L, Sehested A, Klausen C, Broholm H, Nysom K (2015) The use of 5-ALA to assist complete removal of residual non-enhancing part of childhood meduloblastoma: a case report. Childs Nerv Syst 31(11):2173–2177. CrossRefPubMedGoogle Scholar
  23. 23.
    Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ (2000) Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg 93(6):1003–1013. CrossRefPubMedGoogle Scholar
  24. 24.
    Stummer W, Rodrigues F, Schucht P, Preuss M, Wiewrodt D, Nestler U et al (2014) European ALA Pediatric Brain Tumor Study Group: Predicting the "usefulness" of 5-ALA derived tumor fluorescence for fluorescence-guided resection in pediatric brain tumors: data from a European survey. Acta Neurochir 156(12):2315–2324. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sughrue ME, Cho J, Rutkowski MJ, Aranda D, Kane AJ, Barabi IJ, Parsa AT (2011) Clinical features and post-surgical outcome of patients with astroblastoma. J Clin Neurosci 18(6):750–754. CrossRefPubMedGoogle Scholar
  26. 26.
    Unal E, Koksal Y, Vajtai I, Toy H, Kocaogullar Y, Paksoy Y (2008) Astroblastoma in a child. Child Nerv Syst 24(2):165–168. CrossRefGoogle Scholar
  27. 27.
    Yuzawa S, Nishihara H, Tanino M, Kimura T, Moriya J, Kamoshima Y, Nagashima K, Tanaka S (2016) A case of cerebral astroblastoma with rhabdoid features: acytological, histological, and immunohistochemical study. Brain Tumor Pathol 33(1):63–70. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryShizuoka Children’s HospitalAoi-kuJapan

Personalised recommendations