The role of 5-aminolevulinic acid in brain tumor surgery

a systematic review

Nicholas Ferraro, Eric Barbarite, Trevine R. Albert, Emmanuel Berchmans, Ashish H. Shah, Amade Bregy, Michael E. Ivan, Tyler Brown, Ricardo J Komotar

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Recently, 5-aminolevulinic acid (5-ALA) has been utilized as an adjuvant to the surgical resection of primary brain tumors and metastases. We conducted a systematic review of the literature to further understand the role of 5-ALA in neurosurgery. Our goal was to identify the utility of 5-ALA during resection by evaluating its sensitivity and specificity for different tumor types, as well as the extent of tumor resection achieved while using 5-ALA. A search of the literature was conducted using the PubMed database for the period January 1990 through May 2014. Surgical series in which 5-ALA was used for brain neoplasm resections were evaluated for tumor histology, sensitivity, specificity, extent of resection, complications, and outcomes. Twenty-two series, involving 1163 patients, were included in our review. 5-ALA sensitivity was highest in high-grade gliomas (85 %) and meningiomas (81 %). 5-ALA specificity was high in meningiomas (100 %), as well as metastases (84 %) and high-grade gliomas (82 %). Gross total resection (GTR) was achieved using 5-ALA in 66.2 % of all gliomas and 69.6 % of meningiomas, regardless of histological subtype. 5-ALA may be a useful tool in increasing the extent of resection and achieving GTR in intracranial tumors. The resection of tumors for which 5-ALA has high sensitivity and specificity, such as high-grade gliomas, may lead to an increase in extent of resection when compared to operations using only standard white light. Further evidence for the use of 5-ALA in meningiomas and certain subtypes of metastases may be needed to qualify its efficacy.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalNeurosurgical Review
DOIs
StateAccepted/In press - Jan 27 2016

Fingerprint

Aminolevulinic Acid
Brain Neoplasms
Meningioma
Glioma
Neoplasms
Neoplasm Metastasis
Sensitivity and Specificity
Neurosurgery
PubMed
Histology
Databases

Keywords

  • 5-ALA
  • Brain cancer
  • Brain metastases
  • Extent of resection
  • Glioma
  • Outcomes
  • Systematic analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Ferraro, N., Barbarite, E., Albert, T. R., Berchmans, E., Shah, A. H., Bregy, A., ... Komotar, R. J. (Accepted/In press). The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review. Neurosurgical Review, 1-11. https://doi.org/10.1007/s10143-015-0695-2

The role of 5-aminolevulinic acid in brain tumor surgery : a systematic review. / Ferraro, Nicholas; Barbarite, Eric; Albert, Trevine R.; Berchmans, Emmanuel; Shah, Ashish H.; Bregy, Amade; Ivan, Michael E.; Brown, Tyler; Komotar, Ricardo J.

In: Neurosurgical Review, 27.01.2016, p. 1-11.

Research output: Contribution to journalArticle

Ferraro, N, Barbarite, E, Albert, TR, Berchmans, E, Shah, AH, Bregy, A, Ivan, ME, Brown, T & Komotar, RJ 2016, 'The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review', Neurosurgical Review, pp. 1-11. https://doi.org/10.1007/s10143-015-0695-2
Ferraro N, Barbarite E, Albert TR, Berchmans E, Shah AH, Bregy A et al. The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review. Neurosurgical Review. 2016 Jan 27;1-11. https://doi.org/10.1007/s10143-015-0695-2
Ferraro, Nicholas ; Barbarite, Eric ; Albert, Trevine R. ; Berchmans, Emmanuel ; Shah, Ashish H. ; Bregy, Amade ; Ivan, Michael E. ; Brown, Tyler ; Komotar, Ricardo J. / The role of 5-aminolevulinic acid in brain tumor surgery : a systematic review. In: Neurosurgical Review. 2016 ; pp. 1-11.
@article{86dd110e07db49a3878d1b58261e2cbf,
title = "The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review",
abstract = "Recently, 5-aminolevulinic acid (5-ALA) has been utilized as an adjuvant to the surgical resection of primary brain tumors and metastases. We conducted a systematic review of the literature to further understand the role of 5-ALA in neurosurgery. Our goal was to identify the utility of 5-ALA during resection by evaluating its sensitivity and specificity for different tumor types, as well as the extent of tumor resection achieved while using 5-ALA. A search of the literature was conducted using the PubMed database for the period January 1990 through May 2014. Surgical series in which 5-ALA was used for brain neoplasm resections were evaluated for tumor histology, sensitivity, specificity, extent of resection, complications, and outcomes. Twenty-two series, involving 1163 patients, were included in our review. 5-ALA sensitivity was highest in high-grade gliomas (85 {\%}) and meningiomas (81 {\%}). 5-ALA specificity was high in meningiomas (100 {\%}), as well as metastases (84 {\%}) and high-grade gliomas (82 {\%}). Gross total resection (GTR) was achieved using 5-ALA in 66.2 {\%} of all gliomas and 69.6 {\%} of meningiomas, regardless of histological subtype. 5-ALA may be a useful tool in increasing the extent of resection and achieving GTR in intracranial tumors. The resection of tumors for which 5-ALA has high sensitivity and specificity, such as high-grade gliomas, may lead to an increase in extent of resection when compared to operations using only standard white light. Further evidence for the use of 5-ALA in meningiomas and certain subtypes of metastases may be needed to qualify its efficacy.",
keywords = "5-ALA, Brain cancer, Brain metastases, Extent of resection, Glioma, Outcomes, Systematic analysis",
author = "Nicholas Ferraro and Eric Barbarite and Albert, {Trevine R.} and Emmanuel Berchmans and Shah, {Ashish H.} and Amade Bregy and Ivan, {Michael E.} and Tyler Brown and Komotar, {Ricardo J}",
year = "2016",
month = "1",
day = "27",
doi = "10.1007/s10143-015-0695-2",
language = "English (US)",
pages = "1--11",
journal = "Neurosurgical Review",
issn = "0344-5607",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - The role of 5-aminolevulinic acid in brain tumor surgery

T2 - a systematic review

AU - Ferraro, Nicholas

AU - Barbarite, Eric

AU - Albert, Trevine R.

AU - Berchmans, Emmanuel

AU - Shah, Ashish H.

AU - Bregy, Amade

AU - Ivan, Michael E.

AU - Brown, Tyler

AU - Komotar, Ricardo J

PY - 2016/1/27

Y1 - 2016/1/27

N2 - Recently, 5-aminolevulinic acid (5-ALA) has been utilized as an adjuvant to the surgical resection of primary brain tumors and metastases. We conducted a systematic review of the literature to further understand the role of 5-ALA in neurosurgery. Our goal was to identify the utility of 5-ALA during resection by evaluating its sensitivity and specificity for different tumor types, as well as the extent of tumor resection achieved while using 5-ALA. A search of the literature was conducted using the PubMed database for the period January 1990 through May 2014. Surgical series in which 5-ALA was used for brain neoplasm resections were evaluated for tumor histology, sensitivity, specificity, extent of resection, complications, and outcomes. Twenty-two series, involving 1163 patients, were included in our review. 5-ALA sensitivity was highest in high-grade gliomas (85 %) and meningiomas (81 %). 5-ALA specificity was high in meningiomas (100 %), as well as metastases (84 %) and high-grade gliomas (82 %). Gross total resection (GTR) was achieved using 5-ALA in 66.2 % of all gliomas and 69.6 % of meningiomas, regardless of histological subtype. 5-ALA may be a useful tool in increasing the extent of resection and achieving GTR in intracranial tumors. The resection of tumors for which 5-ALA has high sensitivity and specificity, such as high-grade gliomas, may lead to an increase in extent of resection when compared to operations using only standard white light. Further evidence for the use of 5-ALA in meningiomas and certain subtypes of metastases may be needed to qualify its efficacy.

AB - Recently, 5-aminolevulinic acid (5-ALA) has been utilized as an adjuvant to the surgical resection of primary brain tumors and metastases. We conducted a systematic review of the literature to further understand the role of 5-ALA in neurosurgery. Our goal was to identify the utility of 5-ALA during resection by evaluating its sensitivity and specificity for different tumor types, as well as the extent of tumor resection achieved while using 5-ALA. A search of the literature was conducted using the PubMed database for the period January 1990 through May 2014. Surgical series in which 5-ALA was used for brain neoplasm resections were evaluated for tumor histology, sensitivity, specificity, extent of resection, complications, and outcomes. Twenty-two series, involving 1163 patients, were included in our review. 5-ALA sensitivity was highest in high-grade gliomas (85 %) and meningiomas (81 %). 5-ALA specificity was high in meningiomas (100 %), as well as metastases (84 %) and high-grade gliomas (82 %). Gross total resection (GTR) was achieved using 5-ALA in 66.2 % of all gliomas and 69.6 % of meningiomas, regardless of histological subtype. 5-ALA may be a useful tool in increasing the extent of resection and achieving GTR in intracranial tumors. The resection of tumors for which 5-ALA has high sensitivity and specificity, such as high-grade gliomas, may lead to an increase in extent of resection when compared to operations using only standard white light. Further evidence for the use of 5-ALA in meningiomas and certain subtypes of metastases may be needed to qualify its efficacy.

KW - 5-ALA

KW - Brain cancer

KW - Brain metastases

KW - Extent of resection

KW - Glioma

KW - Outcomes

KW - Systematic analysis

UR - http://www.scopus.com/inward/record.url?scp=84955581116&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955581116&partnerID=8YFLogxK

U2 - 10.1007/s10143-015-0695-2

DO - 10.1007/s10143-015-0695-2

M3 - Article

SP - 1

EP - 11

JO - Neurosurgical Review

JF - Neurosurgical Review

SN - 0344-5607

ER -