Fluorescence-Guided Surgery (Making Tumor Visible with Light Using 5-ALA)

An auxiliary method that makes certain brain tumors visible by illuminating them with the help of a special drug and light during surgery, allowing clearer distinction of their boundaries.

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Surgical Technology

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1Overview

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What is this Condition?

Fluorescence-guided surgery is a method that allows certain brain tumors to be seen more clearly during surgery. A few hours before surgery, the patient is given a special drug called 5-ALA. This drug causes accumulation of a substance in tumor cells much more than in healthy brain tissue. During surgery, when the surgeon switches to blue-violet light on the microscope, the tumor area shines in a pink-red color; healthy brain does not shine. This way, the boundaries of the tumor, which are difficult to distinguish with the naked eye, become more distinct and help ensure safe removal of the tumor. This method is particularly valuable in rapidly growing (high-grade) brain tumors. It is not a treatment but an imaging tool that supports surgery, and does not by itself mean every area will be safely removed.

Symptoms

To see tumor boundaries more clearly in rapidly growing, high-grade brain tumors (particularly glioblastoma).

To highlight the infiltrative edges of the tumor that are difficult to distinguish with the naked eye, where the tumor has infiltrated healthy tissue.

In previously operated and recurrent tumors, to distinguish scar tissue from tumor.

To clarify boundaries in some metastatic tumors (spread from other organs) that may have unclear margins.

To help achieve more complete removal of certain dural tumors (meningiomas), particularly those located at the skull base.

To guide high-grade tumors that enhance with contrast on MRI, meaning their boundaries are clear.

Diagnosis Methods

Fluorescence-guided surgery is not a disease but a method that supports surgery; therefore, it does not make a diagnosis but is used in the surgical treatment of a tumor that has usually been diagnosed with MRI. Whether the method is appropriate is determined based on the type of tumor and whether it enhances with contrast on MRI; it is particularly reliable in high-grade tumors. The definitive tumor type is clarified by pathological examination of tissue obtained during surgery.

Treatment Methods

This method is an imaging tool that supports surgery. Approximately 3-4 hours before surgery, the patient takes 5-ALA orally; medication can be given beforehand to reduce nausea. During surgery, the surgeon switches between white light and blue-violet fluorescence light on the microscope. Brightly shining pink-red areas in fluorescence light indicate dense tumor tissue, dimly shining areas indicate infiltrative tumor margins, and non-shining areas are usually healthy brain. While the surgeon removes shining tumor tissue, careful attention is paid to areas near important regions controlling functions such as movement and speech. Due to the medication, the patient is light-sensitive for 24-48 hours after surgery and must be protected from sunlight during this period. The method contributes to safe removal, but the result depends on the tumor location and the surgeon's assessment.

Taking 5-ALA orally 3-4 hours before surgery, causing accumulation of a light-fluorescent substance in tumor cells.

Switching to blue-violet light on the microscope during surgery to observe pink-red fluorescence of the tumor area.

Safe removal of shining tumor tissue while considering the distance to important brain regions.

Performing final verification with fluorescence light after removal to evaluate whether any shining tissue remains.

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

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Endoscopic Tumor Biopsy

Endoscopic Tumor Biopsy procedure

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Glial tümörler, internal dekompresyon, mikrocerrahi ile

Glial tümörler, internal dekompresyon, mikrocerrahi ile procedure

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References

Hadjipanayis CG, ed. Comprehensive Overview of Modern Surgical Approaches to Intrinsic Brain Tumors. London: Academic Press/Elsevier; 2019:232.
Acerbi F, et al. Brain Tumors (Neuromethods serisi). New York: Humana/Springer; 2021:268.
Quiñones-Hinojosa A, ed. Schmidek and Sweet Operative Neurosurgical Techniques. 7th ed. Elsevier; 2021:84.
Stummer W, Pichlmeier U, Meinel T, et al. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol. 2006:392-401.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Fluorescence-Guided Surgery (Making Tumor Visible with Light Using 5-ALA)

Surgical Technology

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Stereotaktik radyocerrahi (SRC) - Gamma Knife, Cyberknife

Stereotaktik radyoterapi (SBRT) - Gamma Knife, Cyberknife

Endoscopic Tumor Biopsy

Glial tümörler, internal dekompresyon, mikrocerrahi ile

References

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Related Treatments

Stereotaktik radyocerrahi (SRC) - Gamma Knife, Cyberknife

Stereotaktik radyoterapi (SBRT) - Gamma Knife, Cyberknife

Endoscopic Tumor Biopsy

Glial tümörler, internal dekompresyon, mikrocerrahi ile

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