Abstract
Glial tumors are one of the most common lesions of the central nervous system. Despite the implementation of appropriate treatment, the prognosis is not successful. As shown in the literature, maximal tumor resection is a key element in improving therapeutic outcome. One of the methods to achieve it is the use of fluorescent intraoperative navigation with 5-aminolevulinic acid. Unfortunately, often the level of fluorescence emitted is not satisfactory, resulting in difficulties in the course of surgery. This article summarizes currently available knowledge regarding differences in the level of emitted fluorescence. It may depend on both the histological type and the genetic profile of the tumor, which is reflected in the activity and expression of enzymes involved in the intracellular metabolism of fluorescent dyes, such as PBGD, FECH, UROS, and ALAS. The transport of 5-aminolevulinic acid and its metabolites across the blood–brain barrier and cell membranes mediated by transporters, such as ABCB6 and ABCG2, is also important. Accompanying therapies, such as antiepileptic drugs or steroids, also have an impact on light emission by tumor cells. Accurate determination of the factors influencing the fluorescence of 5-aminolevulinic acid-treated cells may contribute to the improvement of fluorescence navigation in patients with highly malignant gliomas.
Highlights
Gliomas are among the most common tumors found in neurosurgery
One of the first reports on the use of 5-aminolevulinic acid (5-ALA) in the surgery of low-grade gliomas comes from Ishihara et al The authors, examining 65 slices from six resected tumors, showed that diffuse astrocytomas exhibit noticeably weaker protoporphyrin IX (PpIX) fluorescence compared with anaplastic astrocytomas and glioblastoma [100]
It is important to identify factors that may enhance or disrupt the phenomenon of PpIX fluorescence in glial tumor cells exposed to 5-ALA
Summary
Gliomas are among the most common tumors found in neurosurgery. It is estimated that they constitute 30% of all brain tumors and as much as 80% of malignant lesions [1]. An incomplete resection results in higher risk of neoplasm recurrence and poorer effectiveness of adjuvant therapies, such as radio- and chemotherapy [10,11,12,13,14,15] For this reason, much attention is paid to the improvement of surgical techniques that help to maximize the percentage of achieved GTR. The second unique feature of the dye is its selective accumulation in high-grade glioma cells compared with normal brain tissue. This allows the surgeon to determine the likely margins of the operated lesion while the procedure is still ongoing. The goal of this study is a literature review on the topic of the factors affecting the mechanism of fluorescence induced by the supply of 5-aminolevulinic acid
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