Citation: bassaganyas-vancells, et al.¿combined use of 5-aminolevulinic acid and intraoperative low-field magnetic resonance imaging in high-grade glioma surgery.¿ world neurosurgery.Oct.2019; 130: e206-e212.Https://doi.Org/10.1016/j.Wneu.2019.06.029.Abstract: objective: we sought to assess the impact of 5-aminolevulinic acid (5-ala) and low-field intraoperative magnetic resonance imaging (imri) on the extent of resection of high-grade gliomas (hggs).Results are compared with those obtained when using 5-ala and imri separately.Methods: we retrospectively included patients with an hgg eligible for gross total resection (gtr) from january 2013 to january 2018.Patients were included according to 5-ala surgical guidance (5a-group), imri (imri-group), or both (5a-imri-group).Surgical variables were registered, and presurgical and postsurgical radiologic and clinical variables were analyzed.Extent of resection greater or equal to 90%, complications, and new permanent neurologic deficit were compared using the chi-squared and analysis of variance tests.Other variables studied were mortality, average hospital stay, surgical time, and karnofsky performance scale status before and after surgery.Results: most of the 118 procedures carried out were in men (59.2%).The mean age was 58 years.Sixty patients (50.8%) were operated on using exclusively 5-ala assistance (5a-group), 19 (16.1%) using imri (imri-group), and 39 (33%) combining both techniques (5a-imri-group).There were no statistically significant differences among 3 groups regarding extent of resection greater or equal to 90% (73% 5a, 73.7% imri, 71.8% 5a-imri, p = 0.94); complication rates (18.3% 5a, 5.3% imri, 7.7% 5a-imri, p = 0.17); new or worsening of preexisting neurologic deficit at 1-month follow-up (13.3% 5a, 10.5% imri, 15.4% 5a-imri, p = 0.26); average hospital stay in days (9.5 5a, 6.4 imri, 7.6 5a-imri, p = 0.18); karnofsky performance scale; nor surgical time in minutes (212.4 5a, 187.9 imri, 201.4 5a-imri, p = 0.13).Conclusions: in our experience, combined use of imri and 5-ala does not improve the studied variables when compared with those technologies when used separately, even though a slight tendency of a superior effectiveness is observed when using imri individually.Reported events: one patient in the 5a group died 4 weeks after the surgery due to encephalitis caused by e.Coli and status epilepticus.
|