Skip Navigation LinksHome > March 2014 - Volume 10 - Issue > 5-Aminolevulinic Acid-Induced Protoporphyrin IX Fluorescence...
doi: 10.1227/NEU.0000000000000117
Technique Assessment

5-Aminolevulinic Acid-Induced Protoporphyrin IX Fluorescence in Meningioma: Qualitative and Quantitative Measurements In Vivo

Valdes, Pablo A. PhD*,‡,§; Bekelis, Kimon MD*; Harris, Brent T. MD, PhD; Wilson, Brian C. PhD; Leblond, Frederic PhD‡,#; Kim, Anthony PhD; Simmons, Nathan E. MD*; Erkmen, Kadir MD*; Paulsen, Keith D. PhD‡,**; Roberts, David W. MD*,§,**

Collapse Box


BACKGROUND: The use of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence has shown promise as a surgical adjunct for maximizing the extent of surgical resection in gliomas. To date, the clinical utility of 5-ALA in meningiomas is not fully understood, with most descriptive studies using qualitative approaches to 5-ALA-PpIX.

OBJECTIVE: To assess the diagnostic performance of 5-ALA-PpIX fluorescence during surgical resection of meningioma.

METHODS: ALA was administered to 15 patients with meningioma undergoing PpIX fluorescence-guided surgery at our institution. At various points during the procedure, the surgeon performed qualitative, visual assessments of fluorescence by using the surgical microscope, followed by a quantitative fluorescence measurement by using an intraoperative probe. Specimens were collected at each point for subsequent neuropathological analysis. Clustered data analysis of variance was used to ascertain a difference between groups, and receiver operating characteristic analyses were performed to assess diagnostic capabilities.

RESULTS: Red-pink fluorescence was observed in 80% (12/15) of patients, with visible fluorescence generally demonstrating a strong, homogenous character. Quantitative fluorescence measured diagnostically significant PpIX concentrations (cPpIx) in both visibly and nonvisibly fluorescent tissues, with significantly higher cPpIx in both visibly fluorescent (P < .001) and tumor tissue (P = .002). Receiver operating characteristic analyses also showed diagnostic accuracies up to 90% for differentiating tumor from normal dura.

CONCLUSION: ALA-induced PpIX fluorescence guidance is a potential and promising adjunct in accurately detecting neoplastic tissue during meningioma resective surgery. These results suggest a broader reach for PpIX as a biomarker for meningiomas than was previously noted in the literature.

ABBREVIATIONS: ALA, 5-aminolevulinic acid

AUC, area under the curve

FGR, fluorescence-guided resection

NPV, negative predictive value

PpIX, protoporphyrin IX

PPV, positive predictive value

ROC, receiver operating characteristic

WHO, World Health Organization

Copyright © by the Congress of Neurological Surgeons


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.