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Spectroscopic measurement of 5-ALA-induced intracellular protoporphyrin IX in pediatric brain tumors

  • Original Article - Pediatric Neurosurgery
  • Published:
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Abstract

Objective

5-Aminolevulinic acid (5-ALA)–guided resection of gliomas in adults enables better delineation between tumor and normal brain, allowing improved resection and improved patients’ outcome. Recently, several reports were published regarding 5-ALA for resection of pediatric brain tumors. The aim of the study was to determine the intracellular fluorescence of protoporphyrin IX (PPIX) in pediatric brain tumors by hyperspectral imaging and to compare it with visually observed intraoperative fluorescence.

Methods

5-ALA was administered orally 4 h prior to surgery. During tumor resection, the surgeon assessed the fluorescence signal to be strong, weak, or absent. Subsequently, fluorescence intensity of tumor samples was measured via spectroscopy. In addition, clinical data, imaging, and laboratory data were analyzed.

Results

Eleven children (1–16 years) were operated. Tumor entities included three (n = 3) medulloblastomas, two (n = 2) pilocytic astrocytomas (PA), two (n = 2) anaplastic ependymomas and one (n = 1) diffuse astrocytoma, anaplastic astrocytoma (n = 1), pilomyxoid astrocytoma (n = 1) and anaplastic pleomorphic xanthoastrocytoma (n = 1). Strong fluorescence was visible in all anaplastic tumors and one PA; one PA demonstrated weak fluorescence. Visible fluorescence was strongly associated with intracellular fluorescence intensity and PPIX concentration (P < 0.05). Within all tumors with visible fluorescence, the intracellular PPIX concentration was greater than 4 μg/ml. Except for moderate and transient elevation of liver enzymes, no 5-ALA related adverse events were reported.

Conclusion

We demonstrate a strong association between intraoperative observations and spectrometric measurements of PPIX fluorescence in tumor tissue. As in former studies, fluorescence signal was more commonly observed in malignant glial tumors. Further prospective controlled trials should be conducted to investigate the feasibility of 5-ALA-guided resection of pediatric brain tumors.

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Author notes

  1. Michael Schwake, Sadahiro Kaneko, Angela Brentrup and Walter Stummer contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany

    Michael Schwake, Sadahiro Kaneko, Eric Suero Molina, Michael Müther, Stephanie Schipmann, Michaela Köchling, Angela Brentrup & Walter Stummer

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  1. Michael Schwake
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Correspondence to Michael Schwake.

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Conflict of interest

Walter Stummer has received consultant fees from medac, (Wedel, Germany), Carl Zeiss Meditech (Oberkochen, Germany), and NxDc (Lexington, KY, USA). All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethical committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (2019-400-f-S).

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Informed consent was obtained from all individual participants included in the study.

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Schwake, M., Kaneko, S., Suero Molina, E. et al. Spectroscopic measurement of 5-ALA-induced intracellular protoporphyrin IX in pediatric brain tumors. Acta Neurochir 161, 2099–2105 (2019). https://doi.org/10.1007/s00701-019-04039-4

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  • DOI: https://doi.org/10.1007/s00701-019-04039-4

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