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Safety Profile of 5-Aminolevulinic Acid as a Surgical Adjunct in Clinical Practice: A Review of 207 Cases From 2008 to 2013

Honorato-Cia, Cristina MD*; Martinez-Simón, Antonio MD, PhD*; Cacho-Asenjo, Elena MD, PhD*; Guillén-Grima, Francisco MD, PhD; Tejada-Solís, Sonia MD, PhD; Diez-Valle, Ricardo MD, PhD

Journal of Neurosurgical Anesthesiology: October 2015 - Volume 27 - Issue 4 - p 304–309
doi: 10.1097/ANA.0000000000000172
Clinical Report

Background: 5-Aminolevulinic acid (5-ALA) is used for brain tumor identification during surgery through fluorescence. Its use is linked to side effects such as photodermatosis, anemia, or plaquetopenia. Many institutions take very strict precautions to prevent them. Our hospital´s protocol mandates avoidance of direct sunlight during the first 24 hours only.

Methods: Retrospective cohort observational study of 207 consecutive patients who underwent 5-ALA-guided brain tumor resection between 2008 and 2013, and compared with a control group of 53 patients without 5-ALA.

Results: No skin reaction was reported. No difference was found in hemoglobin or platelet level comparisons at different points in time. There was no difference in trends within groups. Mean duration of surgery was longer in the 5-ALA group; the subgroup of patients undergoing their first surgery had a positive correlation with lower hemoglobin levels. In postoperative magnetic resonance imaging, patients in the 5-ALA group had a lower percentage of residual bleeding (19% of all patients; 17.9% in 5-ALA group and 22.7% in non-ALA [P=0.04]). Eight patients in the 5-ALA group required blood transfusion (3.9%), compared with 2 in the control group (3.8%). Four patients in the 5-ALA group required reintervention in the first 48 hours due to bleeding, although none had platelets <150,000/mL.

Conclusions: Significant side effects appear to be uncommon. Blood count changes are likely multifactorial; surgical time may account for it partially, whereas 5-ALA role is not clear and may not be significant.

Departments of *Anesthesiology and Critical Care

Epidemiology and Preventive Medicine

Neurosurgery, University Hospital of Navarra, Pamplona, Spain

C.H.C.: study design, data collection, and writing. A.M.S.: data collection and significant contribution to the paper. E.C.A.: data collection and final review. F.G.G.: study design and data analysis. S.T.S.: review and contribution to the paper. R.D.V.: review and contribution to the paper.

C.H.C., A.M.-S., and R.D.-V. have received travel funding from GebroPharma Spain.

The authors have no conflicts of interest to disclose.

Reprints: Cristina H. Cia, MD, Department of Anesthesiology and Critical Care, University Hospital of Navarra, Pio XII, 36, Pamplona, 31009, Spain (e-mail:

Received October 26, 2014

Accepted January 20, 2015

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