Price Anthony, Bernstock Joshua D, Truong Nina, Wu Kyle, Lee John Y K, Tucker Isaac J, Gessler Florian, DeSena Salvatore, Friedman Gregory, Valdes Pablo A
John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
Neurosurg Pract. 2024 Nov 19;5(4):e00121. doi: 10.1227/neuprac.0000000000000121. eCollection 2024 Dec.
The purpose of this systematic review was to provide a comprehensive overview of the available literature on 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) fluorescence-guided surgery (FGS) for the resection of brain metastases (BMs).
A comprehensive search of the PubMed database for literature on 5-ALA use in BMs surgery was performed. For inclusion, BMs studies had to have data on the observed intraoperative fluorescence available. Additional data categories included the number of metastatic tumors, 5-ALA dosage and timing, the imaging system (eg, microscope) used, imaging wavelength(s), fluorescence grading ("simple" and "detailed"), fluorescence consistency (heterogeneous vs homogeneous), intracranial tumor location, metastatic primary tumor location, and extent of resection, among others.
Twenty-three articles published between 2007 and 2022 met the inclusion criteria. These studies comprised 1709 total patients; 870 metastatic samples were collected from 855 patients with 377 (43.3%) fluorescence-negative and 493 (56.7%) fluorescence-positive samples. The pooled overall prevalence of fluorescence-positive metastatic lesions was 66% (95% CI 55%-75%; I = 85%, < .01). The fluorescence grading was as follows: (a) simple fluorescence (n = 599): 295 (49.3%) fluorescence-negative and 304 (50.8%) fluorescence-positive samples and (b) detailed fluorescence (n = 271): 82 (30.3%) no fluorescence, 107 (39.5%) weak fluorescence, and 82 (30.3%) strong fluorescence. A total of 764 lesions had primary tumor site data available: 702 lesions had fluorescence data with 384 (54.7%) fluorescence-positive samples.
FGS using 5-ALA/PpIX in BMs demonstrates varying benefits as an adjunct for maximizing the extent of resection. Thus, preoperative knowledge of the primary tumors' origin may inform surgeons regarding the potential utility of 5-ALA/PpIX for FGS management of BMs.
本系统评价的目的是全面综述关于5-氨基乙酰丙酸（5-ALA）诱导的原卟啉IX（PpIX）荧光引导手术（FGS）用于脑转移瘤（BMs）切除的现有文献。
对PubMed数据库进行全面检索，以查找有关5-ALA在BMs手术中应用的文献。纳入的BMs研究必须有术中观察到的荧光数据。其他数据类别包括转移瘤数量、5-ALA剂量和给药时间、使用的成像系统（如显微镜）、成像波长、荧光分级（“简单”和“详细”）、荧光一致性（异质性与同质性）、颅内肿瘤位置、转移原发肿瘤位置以及切除范围等。
2007年至2022年间发表的23篇文章符合纳入标准。这些研究共纳入1709例患者；从855例患者中收集了870个转移样本，其中377个（43.3%）为荧光阴性样本，493个（56.7%）为荧光阳性样本。荧光阳性转移灶的合并总体患病率为66%（95%CI 55%-75%；I² = 85%，P <.01）。荧光分级如下：（a）简单荧光（n = 599）：295个（49.3%）荧光阴性样本和304个（50.8%）荧光阳性样本；（b）详细荧光（n = 271）：82个（30.3%）无荧光、107个（39.5%）弱荧光和82个（30.3%）强荧光。共有764个病灶有原发肿瘤部位数据：702个病灶有荧光数据，其中384个（54.7%）为荧光阳性样本。
在BMs中使用5-ALA/PpIX进行FGS作为辅助手段以最大化切除范围显示出不同的益处。因此，术前了解原发肿瘤的起源可能会告知外科医生5-ALA/PpIX在BMs的FGS管理中的潜在效用。
