Results of surgical treatment of patients with glioblastomas using a combined 5-ala fluorescent-guided resection

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. It was previously shown that 5-ala fluorescence-guided resection (FGR) of malignant gliomas, as compared to white-light microscopy resection, demonstrates a significantly higher frequency of complete removal of the contrast-enhancing tumor and significantly prolongs overall survival. A combination of 5-ala microscopy and endoscopy may provide some benefits for GBM surgery. The purpose of this study was to evaluate the immediate results of combined 5-ala FGR in patients with GBMs. All in all, 80 patients with GBMs were operated at two independent neurosurgical centers. Patients of the first group (n = 40) were operated by using the combination of 5-ala microscopy and endoscopy. The second (control) group patients (n = 40) underwent conventional white light microsurgery. MRI with contrast agent was done preoperatively and within 72 hours after surgery accompanied by volumetric analysis of the tumor. The patients' functional class was determined a day before surgery and 10 days after it. A comparative analysis of GBM resection by using MRI neuronavigation and combined fluorescence-guided navigation shows that the latter considerably increases the total percentage of GBM resection (27.5% and 65% respectively) and improves the functional class in the immediate postoperative period.