Fully-Endoscopic Resection of Deep-Seated Pilocytic Astrocytoma Under 5-Aminolevulinic Acid Fluorescence Guidance: A Technical Note

• Published in: Turkish neurosurgery Vol. 32; no. 5; p. 872
• Main Authors: Mori, Ryosuke, Akasaki, Yasuharu, Fukasawa, Nei, Kawamura, Daichi, Karagiozov, Kostadin, Murayama, Yuichi
• Format: Journal Article
• Language: English
• Published: Turkey 2022
• Subjects: Aminolevulinic Acid; Astrocytoma - diagnostic imaging; Astrocytoma - pathology; Astrocytoma - surgery; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - surgery; Fluorescence; Humans; Levulinic Acids; Magnetic Resonance Imaging; Male; Middle Aged; Photosensitizing Agents
• ISSN: 1019-5149; 2651-5032
• DOI: 10.5137/1019-5149.JTN.35007-21.2

To improve the extent and safety of resecting these deep-seated tumors, we report a novel procedure of minimally invasive endoscopic resection of deep-seated pilocytic astrocytomas under the guidance of 5-aminolevulinic acid (5-ALA) fluorescence undescribed until now. A 53-year-old male presented with a gradually progressing mild right hemiparesis. Imaging studies showed a solid tumor with degenerative cystic formation in the left basal ganglia. The tumor was removed endoscopically via right frontal small craniotomy. The tumor was positive for 5-ALA fluorescence and allowed better detection of the dissection margin of the solid tumor from the surrounding brain tissue. The histopathological diagnosis was pilocytic astrocytoma. No recurrence was observed on follow-up magnetic resonance imaging (MRI) 2 years after surgery, and the patient was fully independent after rehabilitation. This minimally invasive technique, enhanced by intraoperative fluorescence, might be a safe and feasible alternative to open surgery in the removal of deeply located gliomas.