Cortnum Søren, Laursen René Johannes
Department of Neurosurgery, Aarhus University Hospital, Aalborg Hospital, Denmark.
Dan Med J. 2012 Aug;59(8):A4460.
Malignant gliomas remain associated with a poor prognosis despite both surgical treatment and radiochemotherapy.Previous studies have shown that complete resection of contrast-enhancing tumours is achieved in less than 20-30% of patients. 5-aminolevulinic acid (5-ALA) is a pro-drug that leads to accumulation of fluorescent protoporphyrins in malignant gliomas. The fluorescence can be visualized intraoperatively by use of a modified microscope. The Department of Neurosurgery at Aalborg Hospital has recently adopted this new technique as the first centre in Denmark. Our preliminary results are presented as a retrospective case series.
All patients who had undergone 5-ALA fluorescence-guided surgery due to suspected malignant glioma were included. Patients received a standard preoperative dose of Gliolan. All patients had a postoperative cerebral magnetic resonance imaging scan done within 72 hours to determine their postoperative resection status.
To date, 13 patients have undergone fluorescence-guided surgery. Total resection was achieved in 54-70% of the patients depending on the inclusion criteria. Total or near total resection was achieved in 92% of patients.
The small numbers in our case series do not allow for direct comparison to be made, but show that our results on postoperative resection status fall within the range reported in other studies on the efficacy of 5-ALA. The literature offers mounting evidence in support of the role of aggressive cytoreductive surgery in patients with malignant gliomas.
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尽管进行了手术治疗和放化疗，恶性胶质瘤的预后仍然很差。以往研究表明，不到20%-30%的患者能够实现增强扫描肿瘤的完全切除。5-氨基酮戊酸（5-ALA）是一种前体药物，可导致恶性胶质瘤中荧光原卟啉的蓄积。术中可使用改良显微镜观察到荧光。奥尔堡医院神经外科最近作为丹麦首个中心采用了这项新技术。我们的初步结果以回顾性病例系列的形式呈现。
纳入所有因疑似恶性胶质瘤而接受5-ALA荧光引导手术的患者。患者接受标准术前剂量的Gliolan。所有患者在术后72小时内进行了脑部磁共振成像扫描，以确定其术后切除状态。
迄今为止，13例患者接受了荧光引导手术。根据纳入标准，54%-70%的患者实现了全切除。92%的患者实现了全切除或近全切除。
我们病例系列中的病例数量较少，无法进行直接比较，但结果表明，我们在术后切除状态方面的结果处于其他关于5-ALA疗效研究报告的范围内。文献提供了越来越多的证据支持积极的减瘤手术在恶性胶质瘤患者中的作用。
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