5-ALA fluorescence-guided surgery in pediatric brain tumors-a systematic review.
BACKGROUND
5-Aminolevulinic acid (5-ALA)-guided resection of gliomas in adults enables better differentiation between tumor and normal brain tissue, allowing a higher degree of resection, and improves patient outcomes. In recent years, several reports have emerged regarding the use of 5-ALA in other brain tumor entities, including pediatric brains tumors. Since gross total resection (GTR) of many brain tumors in children is crucial and the role of 5-ALA-guided resection of these tumors is not clear, we sought to perform a comprehensive literature review on this topic.


METHODS
A systematic literature review of EMBASE and MEDLINE/PubMed databases revealed 19 eligible publications encompassing 175 5-ALA-guided operations on pediatric brain tumors. To prevent bias, publications were revised independently by two authors.


RESULTS
We found that 5-ALA-guided resection enabled the surgeons to identify the tumor more easily and was considered helpful mainly in cases of glioblastoma (GBM, 21/27, 78%), anaplastic ependymoma WHO grade III (10/14, 71%), and anaplastic astrocytoma (4/6, 67%). In contrast, cases of pilocytic astrocytomas (PAs) and medulloblastomas 5-ALA-guided surgery did not show consistent fluorescent signals and 5-ALA was considered helpful only in 12% and 22% of cases, respectively. Accumulation of fluorescent porphyrins seems to depend on WHO tumor grading. One important finding is that when 5-ALA-guided resections were considered helpful, the degree of resection was higher than is cases where it was not helpful. The rate of adverse events related to 5-ALA was negligible, especially new postoperative sequelae.


CONCLUSION
5-ALA could play a role in resection of pediatric brain tumors. However, further prospective clinical trials are needed.
['Schwake|Michael|M|0000-0003-4062-4785', 'Schipmann|Stephanie|S|', 'Müther|Michael|M|', 'Köchling|Michaela|M|', 'Brentrup|Angela|A|', 'Stummer|Walter|W|']
D000622:Aminolevulinic Acid D001932:Brain Neoplasms D002648:Child D005260:Female D005910:Glioma D006801:Humans D008297:Male D017319:Photosensitizing Agents D011183:Postoperative Complications D025321:Surgery, Computer-Assisted
5-ALA Pediatric brain tumors Tumor resection