PDD in Neuroendoscopy

New neuro-endoscopes are now available which allow endoscopically assisted 5-ALA-fluorescence guided resections to be performed during malignant brain tumour surgery. This technique improves the discrimination between normal and malignant brain tissue. Malignant tissue will show red fluorescence whereas normal tissue will be blue (Figure 1 and Figure 2). Prof. A. A. Potapov and co-workers from the Burdenko Neurosurgical Institute in Moscow reported recently about their clinical use in a group of selected patients[1] who received an oral solution of 5-ALA (Alasens, FGUP GNZ “NIOPIK”, Moscow [2]) prior to surgery.

The advantage of endoscopic assisted microsurgery is the possibility to use an angled endoscope to control regions within the resection cavity which could not be inspected with the microscope without brain retraction (Figure 3). This allows a more thorough inspection of the entire surface of the resection cavity with the benefit of a reduction of any traction to brain tissue. This inspection could lead to the detection of visually hidden tumour remnants, allowing a more complete resection.

[1] Potapov AA, et al. First experience in 5-ALA fluorescence-guided and endoscopically assisted microsurgery of brain tumors. Med Laser App 2008; 23: 202-208.

[2] Important Note: Please refer to the local manufacturer/provider of 5-ALA for the use of 5-ALA in your country since the approval status can be different from country to country.