ALA-induced porphyrin accumulation in medulloblastoma and its use for fluorescence-guided surgery.

Eicker S et al. ALA-induced Porphyrin Accumulation in Medulloblastoma ... Cen Eur Neurosurg 2011; 72: 101 – 104 Introduction ▼ Medulloblastoma is the most common malignant brain tumor in children. Most children with this disease are treated in controlled studies to improve survival and advance cure rates [6] . The current treatment includes surgical resection, radiotherapy and chemotherapy. Depending on the classifi cation into standardrisk (age ≥ 4 years, non-metastatic disease, and complete or almost complete tumor resection) and high-risk patients, the treatment options diff er, ranging from postoperative chemotherapy alone [18] , to postoperative chemotherapy and radiotherapy, to stem cell therapy in the case of recurrence [5] . According to the classifi cation, maximum cytoreductive surgery appears to be essential for the effi cacy of adjuvant treatment. All controlled studies so far have aimed at optimizing adjuvant therapies, i. e., chemotherapy and radiotherapy, but to our knowledge none have been devoted to improving surgery. We report the fi rst operation performed with fl uorescence guidance using 5-aminolevulinic acid (ALA) for the resection of medulloblastoma to avoid incomplete tumor resection as a favorable basis for adjuvant therapy [11] .