Department of Neurosurgery, Neurological Institute of Curitiba, Jeremias Maciel Perretto 300, 81210-310, Curitiba, Brazil.
Department of Neuroradiology, Neurological Institute of Curitiba, Curitiba, Brazil.
Neurosurg Rev. 2022 Oct;45(5):3139-3148. doi: 10.1007/s10143-022-01843-y. Epub 2022 Aug 16.
Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is used to assist brain tumor resection, especially for high-grade gliomas but also for low-grade gliomas, metastasis, and meningiomas. With the increasing use of this technique, even to assist biopsies, high-grade glioma-mimicking lesions had misled diagnosis by showing 5-ALA fluorescence in non-neoplastic lesions such as radiation necrosis and inflammatory or infectious disease. Since only isolated reports have been published, we systematically review papers reporting non-neoplastic lesion cases with 5-ALA according with the PRISMA guidelines, present our series, and discuss its pathophysiology. In total, 245 articles were identified and 12 were extracted according to our inclusion criteria. Analyzing 27 patients, high-grade glioma was postulated as preoperative diagnosis in 48% of the cases. Microsurgical resection was performed in 19 cases (70%), while 8 patients were submitted to biopsy (30%). We found 4 positive cases in demyelinating disease (50%), 4 in brain abscess (80%), 1 in neurocysticercosis (33%), 1 in neurotoxoplasmosis, infarction, and hematoma (100%), 4 in inflammatory disease (80%), and 3 in cortical dysplasia (100%). New indications are being considered especially in benign lesion biopsies with assistance of 5-ALA. Using fluorescence as an aid in biopsies may improve procedure time, number of samples, and necessity of intraoperative pathology. Further studies should include this technology to encourage more beneficial uses.
荧光引导手术联合 5-氨基酮戊酸（5-ALA）用于辅助脑肿瘤切除，特别是高级别胶质瘤，但也用于低级别胶质瘤、转移瘤和脑膜瘤。随着该技术的应用越来越广泛，甚至用于辅助活检，具有高级别胶质瘤特征的病变通过在非肿瘤性病变中显示 5-ALA 荧光而导致误诊，这些非肿瘤性病变包括放射性坏死和炎症或感染性疾病。由于仅有孤立的报道发表，我们按照 PRISMA 指南系统地回顾了报道 5-ALA 非肿瘤性病变病例的文献，报告了我们的系列病例，并讨论了其病理生理学。总共确定了 245 篇文章，根据纳入标准提取了 12 篇。分析了 27 例患者，在 48%的病例中，术前诊断为高级别胶质瘤。19 例（70%）患者行显微镜下切除术，8 例（30%）患者行活检。我们发现脱髓鞘疾病（50%）中 4 例阳性，脑脓肿（80%）中 4 例阳性，神经囊虫病（33%）中 1 例阳性，神经弓形体病、梗死和血肿（100%）中 1 例阳性，炎症性疾病（80%）中 4 例阳性，皮质发育不良（100%）中 3 例阳性。特别是在使用 5-ALA 辅助良性病变活检时，正在考虑新的适应证。将荧光作为活检的辅助手段，可能会缩短手术时间，增加样本数量，并减少术中病理的需求。应进一步开展研究，包括应用该技术，以鼓励更多有益的用途。
