Fluorescence-guided resections of malignant gliomas — an overview

  • W. Stummer
  • H. J. Reulen
  • A. Novotny
  • H. Steppe
  • J. C. Tonn
Part of the Acta Neurochirurgica Supplements book series (NEUROCHIRURGICA, volume 88)


Radical resections of contrast-enhancing tumour in patients with malignant gliomas may be pertinent for survival but are often difficult to achieve due to uncertainties in distinguishing tumour margins intra-operatively. In this respect a number of novel methods are being examined which aim at enhancing resections. Among these methods, resections that exploit the accumulation of fluorescent porphyrins within malignant glioma tissue in response to exogenous administration of a metabolic percursor, 5-aminolevulinic acid, may offer particular advantages. This article summarises the clinical background and current status of 5-ALA drug development for fluorescence-guided resections of malignant gliomas and analyses the available literature with regard to possible mechanisms that govern the highly specific accumulation of fluorescent porphyrins in malignant glioma tissue in response to 5-ALA administration.


Malignant Glioma Karnofsky Status Fluorescence Accumulation Early Postoperative Magnetic Resonance Imaging Malignant Glioma Tissue 
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  1. 1.
    Albert FK, Forsting M, Sartor K, Adams HP, Kunze S (1994) Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34: 4560Google Scholar
  2. 2.
    Ennis SR, Novotny A, Xiang J, Shakui P, Masada T, Stummer W, Smith DE, Keep RF (2003) Transport of 5-Aminolevulinic Acid Between Blood and Brain. Brain Res 959: 226–234PubMedCrossRefGoogle Scholar
  3. 3.
    McGillion FB, Thompson GG, Moore MR, Goldberg A (1974) The passage of delta-aminolaevulinic acid across the blood-brain barrier of the rat: effect of ethanol. Biochem Pharmacol 23: 472–474PubMedCrossRefGoogle Scholar
  4. 4.
    Garcia SC, Moretti MB, Garay MV, Batlle A (1998) Deltaaminolevulinic acid transport through blood-brain barrier. Gen Pharmacol 31: 579–582PubMedCrossRefGoogle Scholar
  5. 5.
    Keep RF (2001) The blood-brain barrier. In: Walz W (ed) The neuronal environment: brain homeostasis in health and disease. Humana Press Inc, Totowa, pp 277–307Google Scholar
  6. 6.
    Kiss R, Dewitte O, Decaestecker C (1997) The combined determination of proliferative activity and cell density in the prognosis of adult patients with supratentorial high-grade astrocytic tumors. Am J Clin Pathol 107: 321–331PubMedGoogle Scholar
  7. 7.
    Kowalczuk A, Macdonald RL, Amidei C, Dohrmann III F, Erickson RK, Hekmatpanah J, Krauss S, Krishnasamy S, Masters G, Mullan SF, Mundt AJ, Sweeney P, Vokes EE, Weir BKA, Wollman RL (1997) Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. Neurosurgery 41: 1028–1038PubMedCrossRefGoogle Scholar
  8. 8.
    Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Micahle C, Miller D, Sawaya R (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95: 190–198PubMedCrossRefGoogle Scholar
  9. 9.
    Stewart DJ (1994) A critique of the role of the blood-brain barrier in the chemotherapy of human brain tumors. J Neurooncol 20(2): 121–139PubMedCrossRefGoogle Scholar
  10. 10.
    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: 1003–1013PubMedCrossRefGoogle Scholar
  11. 11.
    Terr L, Weiner LP (1983) An Autoradiographic Study of DeltaAminolevulinic Acid Uptake by Mouse Brain. Exp Neurol 79: 564–568PubMedCrossRefGoogle Scholar
  12. 12.
    Wood RJ, Green SB, Shapiro WR (1988) The prognostic importance of tumor size in malignant gliomas: A computed tomographic scan study by the brain tumor cooperative Group. J Clin Oncol 6: 338–343PubMedGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2003

Authors and Affiliations

  • W. Stummer
    • 1
  • H. J. Reulen
    • 2
  • A. Novotny
    • 2
  • H. Steppe
    • 2
  • J. C. Tonn
    • 2
  1. 1.Department of NeurosurgeryHeinrich-Heine Universität DüsseldorfGermany
  2. 2.Department of Neurosurgery and Laser Research LaboratoryKlinikum Grosshadern,Ludwig-Maximilians-UniversityMunichGermany

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