Maragkos Georgios A, Schüpper Alexander J, Lakomkin Nikita, Sideras Panagiotis, Price Gabrielle, Baron Rebecca, Hamilton Travis, Haider Sameah, Lee Ian Y, Hadjipanayis Constantinos G, Robin Adam M
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States.
Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States.
Front Neurol. 2021 Mar 9;12:644804. doi: 10.3389/fneur.2021.644804. eCollection 2021.
Fluorescence-guided surgery (FGS) using 5-aminolevulic acid (5-ALA) is a widely used strategy for delineating tumor tissue from surrounding brain intraoperatively during high-grade glioma (HGG) resection. 5-ALA reaches peak plasma levels ~4 h after oral administration and is currently approved by the FDA for use 2-4 h prior to induction to anesthesia. To demonstrate that there is adequate intraoperative fluorescence in cases undergoing surgery more than 4 h after 5-ALA administration and compare survival and radiological recurrence to previous data. Retrospective analysis of HGG patients undergoing FGS more than 4 h after 5-ALA administration was performed at two institutions. Clinical, operative, and radiographic pre- and post-operative characteristics are presented. Sixteen patients were identified, 6 of them female (37.5%), with mean (SD) age of 59.3 ± 11.5 years. Preoperative mean modified Rankin score (mRS) was 2 ± 1. All patients were dosed with 20 mg/kg 5-ALA the morning of surgery. Mean time to anesthesia induction was 425 ± 334 min. All cases had adequate intraoperative fluorescence. Eloquent cortex was involved in 12 cases (75%), and 13 cases (81.3%) had residual contrast enhancement on postoperative MRI. Mean progression-free survival was 5 ± 3 months. In the study period, 6 patients died (37.5%), mean mRS was 2.3 ± 1.3, Karnofsky score 71.9 ± 22.1, and NIHSS 3.9 ± 2.4. Here we demonstrate that 5-ALA-guided HGG resection can be performed safely more than 4 h after administration, with clinical results largely similar to previous reports. Relaxation of timing restrictions could improve procedure workflow in busy neurosurgical centers, without additional risk to patients.
使用5-氨基乙酰丙酸（5-ALA）的荧光引导手术（FGS）是一种在高级别胶质瘤（HGG）切除术中从周围脑组织中术中勾勒肿瘤组织的广泛使用的策略。5-ALA在口服给药后约4小时达到血浆峰值水平，目前已被美国食品药品监督管理局（FDA）批准在诱导麻醉前2-4小时使用。以证明在5-ALA给药后超过4小时进行手术的病例中存在足够的术中荧光，并将生存率和放射学复发率与先前的数据进行比较。在两个机构对5-ALA给药后超过4小时接受FGS的HGG患者进行了回顾性分析。呈现了临床、手术以及术前和术后的影像学特征。确定了16例患者，其中6例为女性（37.5%），平均（标准差）年龄为59.3±11.5岁。术前平均改良Rankin评分（mRS）为2±1。所有患者在手术当天早晨给予20mg/kg的5-ALA。平均诱导麻醉时间为425±334分钟。所有病例均有足够的术中荧光。12例（75%）累及功能区皮质，13例（81.3%）术后MRI有残留对比增强。平均无进展生存期为5±3个月。在研究期间，6例患者死亡（37.5%），平均mRS为2.3±1.3，卡诺夫斯基评分71.9±22.1，美国国立卫生研究院卒中量表（NIHSS）评分为3.9±2.4。在此我们证明，5-ALA引导的HGG切除可以在给药后超过4小时安全地进行，临床结果与先前的报告基本相似。放宽时间限制可以改善繁忙神经外科中心的手术流程，而不会给患者带来额外风险。
