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With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas
High-grade gliomas (HGGs) are the most frequent primary malignant brain tumors in adults, which lead to death within two years of diagnosis. Maximal safe resection of malignant gliomas as the first step of multimodal therapy is an accepted goal in malignant glioma surgery. Gross total resection has...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836050/ https://www.ncbi.nlm.nih.gov/pubmed/29414911 http://dx.doi.org/10.3390/brainsci8020031 |
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author | Maugeri, Rosario Villa, Alessandro Pino, Mariangela Imperato, Alessia Giammalva, Giuseppe Roberto Costantino, Gabriele Graziano, Francesca Gulì, Carlo Meli, Francesco Francaviglia, Natale Iacopino, Domenico Gerardo |
author_facet | Maugeri, Rosario Villa, Alessandro Pino, Mariangela Imperato, Alessia Giammalva, Giuseppe Roberto Costantino, Gabriele Graziano, Francesca Gulì, Carlo Meli, Francesco Francaviglia, Natale Iacopino, Domenico Gerardo |
author_sort | Maugeri, Rosario |
collection | PubMed |
description | High-grade gliomas (HGGs) are the most frequent primary malignant brain tumors in adults, which lead to death within two years of diagnosis. Maximal safe resection of malignant gliomas as the first step of multimodal therapy is an accepted goal in malignant glioma surgery. Gross total resection has an important role in improving overall survival (OS) and progression-free survival (PFS), but identification of tumor borders is particularly difficult in HGGS. For this reason, imaging adjuncts, such as 5-aminolevulinic acid (5-ALA) or fluorescein sodium (FS) have been proposed as superior strategies for better defining the limits of surgical resection for HGG. 5-aminolevulinic acid (5-ALA) is implicated as precursor in the synthetic pathway of heme group. Protoporphyrin IX (PpIX) is an intermediate compound of heme metabolism, which produces fluorescence when excited by appropriate light wavelength. Malignant glioma cells have the capacity to selectively synthesize or accumulate 5-ALA-derived porphyrins after exogenous administration of 5-ALA. Fluorescein sodium (FS), on the other hand, is a fluorescent substance that is not specific to tumor cells but actually it is a marker for compromised blood-brain barrier (BBB) areas. Its effectiveness is confirmed by multicenter phase-II trial (FLUOGLIO) but lack of randomized phase III trial data. We conducted an analytic review of the literature with the objective of identifying the usefulness of 5-ALA and FS in HGG surgery in adult patients. |
format | Online Article Text |
id | pubmed-5836050 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-58360502018-03-07 With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas Maugeri, Rosario Villa, Alessandro Pino, Mariangela Imperato, Alessia Giammalva, Giuseppe Roberto Costantino, Gabriele Graziano, Francesca Gulì, Carlo Meli, Francesco Francaviglia, Natale Iacopino, Domenico Gerardo Brain Sci Review High-grade gliomas (HGGs) are the most frequent primary malignant brain tumors in adults, which lead to death within two years of diagnosis. Maximal safe resection of malignant gliomas as the first step of multimodal therapy is an accepted goal in malignant glioma surgery. Gross total resection has an important role in improving overall survival (OS) and progression-free survival (PFS), but identification of tumor borders is particularly difficult in HGGS. For this reason, imaging adjuncts, such as 5-aminolevulinic acid (5-ALA) or fluorescein sodium (FS) have been proposed as superior strategies for better defining the limits of surgical resection for HGG. 5-aminolevulinic acid (5-ALA) is implicated as precursor in the synthetic pathway of heme group. Protoporphyrin IX (PpIX) is an intermediate compound of heme metabolism, which produces fluorescence when excited by appropriate light wavelength. Malignant glioma cells have the capacity to selectively synthesize or accumulate 5-ALA-derived porphyrins after exogenous administration of 5-ALA. Fluorescein sodium (FS), on the other hand, is a fluorescent substance that is not specific to tumor cells but actually it is a marker for compromised blood-brain barrier (BBB) areas. Its effectiveness is confirmed by multicenter phase-II trial (FLUOGLIO) but lack of randomized phase III trial data. We conducted an analytic review of the literature with the objective of identifying the usefulness of 5-ALA and FS in HGG surgery in adult patients. MDPI 2018-02-07 /pmc/articles/PMC5836050/ /pubmed/29414911 http://dx.doi.org/10.3390/brainsci8020031 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Maugeri, Rosario Villa, Alessandro Pino, Mariangela Imperato, Alessia Giammalva, Giuseppe Roberto Costantino, Gabriele Graziano, Francesca Gulì, Carlo Meli, Francesco Francaviglia, Natale Iacopino, Domenico Gerardo With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas |
title | With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas |
title_full | With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas |
title_fullStr | With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas |
title_full_unstemmed | With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas |
title_short | With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas |
title_sort | with a little help from my friends: the role of intraoperative fluorescent dyes in the surgical management of high-grade gliomas |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836050/ https://www.ncbi.nlm.nih.gov/pubmed/29414911 http://dx.doi.org/10.3390/brainsci8020031 |
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