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: 11 patients in the 5a-imri group had re-operations.
8 patients in the 5a-imri group had an occurrence of a new neurologic deficit or worsening of preexisting deficit in the immediate postoperative period.
6 of these patients had these deficits remaining one month post-operatively.
1 patient in the 5a-imri group had superficial infection of the surgical wound.
1 patient in the 5a-imri group had meningitis (listeria).
1 patients in the 5a-imri group had an epidural hematoma.
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