Use of 5-Aminolevulinic Acid for Confirmation of Lesional Biopsy Sample in Presumed High-Grade Glioma.

BACKGROUND: 5-amniolevulinic acid (5-ALA) assists neurosurgeons in defining operative margins during resection of high-grade gliomas, leading to improved rates of complete resection of enhancing tumor and progression-free survival. Here, we propose the use of 5-ALA in stereotactic biopsy for confirmation that the sample obtained is from the targeted mass. To the knowledge of the authors, this is the first known record of 5-ALA use for confirmation of pathologic specimen in stereotactic brain biopsy in the United States. This technique could be pivotal for lesions in highly eloquent areas where it is important to take as little tissue as possible in an effort to decrease neurologic deficits while still obtaining a diagnostic biopsy sample.

CASE DESCRIPTION: The patient is a 67-year-old male who initially presented with computed tomography and magnetic resonance imaging concerning for a high-grade glioma in the right basal ganglia and deep white matter of the frontal lobe. Final pathology concluded that specimens obtained during biopsy were indeed pathologic at the periphery of the lesion, and there was necrotic tissue at the center of the lesion. Fluorescence of biopsy samples was 100% concordant with pathologic analysis.

CONCLUSIONS: 5-ALA may prove a useful tool for intraoperative confirmation of pathologic tissue, especially in areas of high eloquence, where small biopsy sizes are essential. It may also obviate the need for an intraoperative consultation to a pathologist. However, additional studies with larger study populations are warranted.