• World Neurosurg · Oct 2019

    Combined use of 5-Aminolevulinic Acid and Low-field Intraoperative Magnetic Resonance Imaging in High-Grade Glioma surgery.

    • Clara Bassaganyas-Vancells, Pedro Roldán, Juan José González, Abel Ferrés, Sergio García, Diego Culebras, Jhon Hoyos, Luis Reyes, Jorge Torales, and Joaquim Enseñat.
    • Department of Neurosurgery, Hospital Clínic de Barcelona, Spain.
    • World Neurosurg. 2019 Oct 1; 130: e206-e212.

    ObjectiveWe sought to assess the impact of 5-aminolevulinic acid (5-ALA) and low-field intraoperative magnetic resonance imaging (iMRI) on the extent of resection of high-grade gliomas (HGGs). Results are compared with those obtained when using 5-ALA and iMRI separately.MethodsWe retrospectively included patients with an HGG eligible for gross total resection (GTR) from January 2013 to January 2018. Patients were included according to 5-ALA surgical guidance (5A-group), iMRI (iMRI-group), or both (5A-iMRI-group). Surgical variables were registered, and presurgical and postsurgical radiologic and clinical variables were analyzed. Extent of resection ≥90%, complications, and new permanent neurologic deficit were compared using the chi-squared and analysis of variance tests. Other variables studied were mortality, average hospital stay, surgical time, and Karnofsky Performance Scale status before and after surgery.ResultsMost of the 118 procedures carried out were in men (59.2%). The mean age was 58 years. Sixty patients (50.8%) were operated on using exclusively 5-ALA assistance (5A-group), 19 (16.1%) using iMRI (iMRI-group), and 39 (33%) combining both techniques (5A-IMRI-group). There were no statistically significant differences among 3 groups regarding extent of resection ≥90% (73% 5A, 73.7% iMRI, 71.8% 5A-iMRI, P = 0.94); complication rates (18.3% 5A, 5.3% iMRI, 7.7% 5A-iMRI, P = 0.17); new or worsening of preexisting neurologic deficit at 1-month follow-up (13.3% 5A, 10.5% iMRI, 15.4% 5A-iMRI, P = 0.26); average hospital stay in days (9.5 5A, 6.4 iMRI, 7.6 5A-iMRI, P = 0.18); Karnofsky Performance Scale; nor surgical time in minutes (212.4 5A, 187.9 iMRI, 201.4 5A-iMRI, P = 0.13).ConclusionsIn our experience, combined use of iMRI and 5-ALA does not improve the studied variables when compared with those technologies when used separately, even though a slight tendency of a superior effectiveness is observed when using iMRI individually.Copyright © 2019 Elsevier Inc. All rights reserved.

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