Department of Neurosurgery, Tel Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Neurosurgery, Tel Aviv Medical Center, Tel-Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Eur J Surg Oncol. 2019 Dec;45(12):2375-2378. doi: 10.1016/j.ejso.2019.07.001. Epub 2019 Jul 2.
Abnormal tissue in stereotactic brain biopsies (SBB) is traditionally identified intraoperatively via pathological frozen section (FS), a time-consuming and error-prone process. The objective of this study was to assess the efficacy of 5-aminolevulinic acid (5-ALA) administration on SBB operation time, diagnostic yield, and the associated complication rate.
We retrospectively evaluated all consecutive patients undergoing SBB with preoperative 5-ALA administration and intraoperative assessment of fluorescence (5-ALA group) between 2010 and 2017 in a single center. They were compared to all consecutive patients who underwent traditional brain biopsy with FS (control group). Demographics, clinical data, diagnostic yield of biopsies, and complication rates were documented.
In all, 376 patients underwent SBB for suspected oncological pathology during the study period. All 34 of the 5-ALA-assisted SBB were diagnostic compared to 96.8% of the control group. The mean operative time was the same for both groups, but it was significantly shorter for the 5-ALA patients with florescent samples compared to patients with negative fluorescence (61 ± 25 min vs. 136 ± 54 min, P = 0.003) and compared to the control group (74 ± 34 min vs. 61 ± 25 min, P = 0.03). Symptomatic bleed was absent in the 5-ALA group and present in 5.4% of the controls. No adverse events were associated with preoperative 5-ALA administration.
Preoperative administration of 5-ALA may improve the diagnostic yield of SBB and shortens operation time in cases of fluorescent pathological tissue. In addition, it may reduce the risk for associated postoperative symptomatic bleed. 5-ALA-assisted SBB is a viable alternative to traditional biopsies with FS.
立体定向脑活检（SBB）中的异常组织传统上通过病理冷冻切片（FS）在术中进行识别，这是一个耗时且容易出错的过程。本研究的目的是评估 5-氨基酮戊酸（5-ALA）给药对 SBB 手术时间、诊断率和相关并发症发生率的影响。
我们回顾性评估了 2010 年至 2017 年在一家中心接受术前 5-ALA 给药和术中荧光评估的所有连续 SBB 患者（5-ALA 组），并与所有接受传统 FS 脑活检的连续患者进行比较（对照组）。记录患者的人口统计学、临床数据、活检诊断率和并发症发生率。
在研究期间，共有 376 例患者因疑似肿瘤病理学而行 SBB。所有 34 例接受 5-ALA 辅助 SBB 的患者均为诊断性，而对照组为 96.8%。两组的平均手术时间相同，但荧光样本阳性患者的手术时间明显短于荧光样本阴性患者（61±25 分钟比 136±54 分钟，P=0.003），也短于对照组（74±34 分钟比 61±25 分钟，P=0.03）。5-ALA 组无症状性出血，对照组为 5.4%。术前 5-ALA 给药与任何不良事件无关。
术前给予 5-ALA 可能提高 SBB 的诊断率，并缩短荧光组织的手术时间。此外，它可能降低与术后症状性出血相关的风险。5-ALA 辅助 SBB 是传统 FS 活检的可行替代方法。
