Awake magic: glioblastoma resection under 5-aminolevulinic acid guidance during awake craniotomy. A case report with video demonstration

Aidos Moldabekov 1, Aiman Maidan 1 * , Nurzhan Ryskeldiyev 1, Nurali Ashirov 2, Serik Akshulakov 1
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1 Department of Brain Neurosurgery, National Centre for Neurosurgery, Astana, Kazakhstan
2 Department of Minimal Invasive Neurosurgery, National Centre for Neurosurgery, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 1, pp. 93-96. https://doi.org/10.23950/jcmk/14273
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Author Contributions
Conceptualization, A. M.; methodology, A. M.; validation, N. A.; formal analysis, A. M.; investigation, A. M.; resources, A. M.; data curation, A. M.; writing – original draft preparation, A. M.; writing – review and editing, A. M.; visualization, N. R.; supervision, S. A.; project administration, S. A.; funding acquisition, N. R. All authors have
read and agreed to the published version of the manuscript.

Statement of Informed Consent: The patient provided her written informed consent to participate in this study.

ABSTRACT

An awake craniotomy's primary goal is to remove the tumor or damaged cells as much as possible without affecting the patient's capacity for clear thought or other crucial functions. This surgical procedure offers a better prognosis by balancing the maximum removal of lesions with the preservation of working zones. For patients with malignant gliomas, the current neurosurgical objective is for resection the large part of a tumor using contrast and not causing neurological deficits. Neurooncological patients are required to have further chemotherapy and radiotherapy, with a control MRI of the brain in 3 and 6 months. Real multidisciplinary work should be provided to improve each patient's quality of life and overall survival. This paper aims to report single case of successful awake craniotomy with fluorescence guidance and discuss the outcomes of the performed surgery.

CITATION

Moldabekov A, Maidan A, Ryskeldiyev N, Ashirov N, Akshulakov S. Awake magic: glioblastoma resection under 5-aminolevulinic acid guidance during awake craniotomy. A case report with video demonstration. J CLIN MED KAZ. 2024;21(1):93-6. https://doi.org/10.23950/jcmk/14273

REFERENCES

  • Hadjipanayis CG, Widhalm G, Stummer W. What is the Surgical Benefit of Utilizing 5-Aminolevulinic Acid for Fluorescence-Guided Surgery of Malignant Gliomas? Neurosurgery. 2015; 77(5): 663-73. https://doi.org/10.1227/NEU.0000000000000929. PMID: 26308630; PMCID: PMC4615466.
  • Zhang JJY, Lee KS, Voisin MR, Hervey-Jumper SL, Berger MS, Zadeh G. Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis. Neuro-oncology advances. 2020; 2(1): vdaa111. https://doi.org/10.1093/noajnl/vdaa111. PMID: 33063012; PMCID: PMC7542985
  • Sun R, Cuthbert H, Watts C. Fluorescence-Guided Surgery in the Surgical Treatment of Gliomas: Past, Present and Future. Cancers (Basel). 2021; 13(14): 3508. https://doi.org/10.3390/cancers13143508. PMID: 34298721; PMCID: PMC8304525.
  • Kim RB, Cohen-Gadol AA. Language Mapping for Glioma. 2016 Jan 1 [cited 2023 Jul 13]; Available from: https://www.growkudos.com/publications/10.18791%252Fnsatlas.v4.ch02.7/reader.
  • Corns R, Mukherjee S, Johansen A, Sivakumar G. 5-aminolevulinic acid guidance during awake craniotomy to maximise extent of safe resection of glioblastoma multiforme. BMJ Case Rep. 2015; 2015: bcr2014208575. https://doi.org/10.1136/bcr-2014-208575.
  • Kasymova AB; Zhetpisbayev BB; Solodovnikov MP; Rakymzhan AK; Ryskeldiyev NA. Organizatsiya biobanka v neyrokhirurgii (Organization of biobank in neurosurgery) [In Russian]. Nejrohirurgiâ i nevrologiâ Kazahstana (Neurosurgery and neurology of Kazakhstan). 2021; 64: 3-10. https://doi.org/10.53498/24094498_2021_3_3.
  • Kulikov A, Lubnin A. Anesthesia for awake craniotomy. Curr Opin Anaesthesiol. 2018; 31(5): 506-510. https://doi.org/10.1097/ACO.0000000000000625.
  • Della Puppa A, De Pellegrin S, d'Avella E et al. 5-aminolevulinic acid (5-ALA) fluorescence guided surgery of high-grade gliomas in eloquent areas assisted by functional mapping. Our experience and review of the literature. Acta Neurochir. 2013; 155(6): 965-972. https://doi.org/10.1007/s00701-013-1660-x.
  • Müther M et al. “5-Aminolevulinic Acid Fluorescence-Guided Resection of 18F-FET-PET Positive Tumor Beyond Gadolinium Enhancing Tumor Improves Survival in Glioblastoma.” Neurosurgery. 2019; 85 (6): E1020-E1029. https://doi.org/10.1093/neuros/nyz199.
  • Save AV, Gill BJ, D'amico RS, Canoll P, Bruce JN. Fluorescein-guided resection of gliomas. Journal of neurosurgical sciences. 2019; 63(6): 648-655. https://doi.org/10.23736/S0390-5616.19.04738-6. PMID: 31961117.
  • Goryaynov SA, Buklina SB, Khapov IV et al. 5-ALA-guided tumor resection during awake speech mapping in gliomas located in eloquent speech areas: Single-center experience. Front Oncol. 2022; 12: 940951. Published 2022 Sep 23. https://doi.org/10.3389/fonc.2022.940951.
  • Zhang K, Gelb AW. Awake craniotomy: indications, benefits, and techniques. Colombian Journal of Anesthesiology. 2018; 46(2S): 46-51. https://doi.org/10.1097/CJ9.0000000000000045.
  • Duffau H. Updated perspectives on awake neurosurgery with cognitive and emotional assessment for patients with low-grade gliomas. Expert Review of Neurotherapeutics. 2021. Apr 3; 21(4): 463-73.
  • Piccioni F, Fanzio M. Management of anesthesia in awake craniotomy. Minerva Anestesiologica. 2008; 74(7-8): 393-408. PMID: 18612268.
  • Goettel N, Bharadwaj S, Venkatraghavan L, Mehta J, Bernstein M, Manninen PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. British journal of anesthesia. 2016; 116(6): 811-21. https://doi.org/10.1093/bja/aew024. Epub 2016 Apr 20. PMID: 27099154.
  • Groshev A, Padalia D, Patel S, et al. Clinical outcomes from maximum-safe resection of primary and metastatic brain tumors using awake craniotomy. Clin Neurol Neurosurg. 2017; 157: 25-30. https://doi.org/10.1016/j.clineuro.2017.03.017.
  • Gandhi S, Tayebi MA, Belykh E, Cavallo C, Zhao X, Syed MP et al. Survival Outcomes Among Patients with High-Grade Glioma Treated With 5-Aminolevulinic Acid-Guided Surgery: A Systematic Review and Meta-Analysis. Frontiers in oncology. 2019; 9: 620. https://doi.org/10.3389/fonc.2019.00620. PMID: 31380272; PMCID: PMC6652805.
  • Conroy MC, Lacey B, Bešević J, Omiyale W, Feng Q, Effingham M, Sellers J, Sheard S, Pancholi M, Gregory G, Busby J. UK Biobank: a globally important resource for cancer research. British Journal of Cancer. 2023; 16; 128(4): 519-27. https://doi.org/10.1038/s41416-022-02053-5.
  • Patil S, Majumdar B, Awan KH, Sarode GS, Sarode SC, Gadbail AR, Gondivkar S. Cancer oriented biobanks: A comprehensive review. Oncol Rev. 2018; 12(1): 357. https://doi.org/10.4081/oncol.2018.357. PMID: 30057691; PMCID: PMC6047884.
  • Wen J, Chen Wanbin, Zhu Y, Zhang P. Clinical features associated with the efficacy of chemotherapy in patients with glioblastoma (GBM): a surveillance, epidemiology, and end results (SEER) analysis. 2021 Jan 19 [cited 2023 Jul 13]; 21(1). Available from: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-021-07800-0.