5-Aminolevulinic acid-induced protoporphyrin IX fluorescence in meningioma: Qualitative and quantitative measurements in Vivo

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

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)74-82
Number of pages9
Issue number1
StatePublished - 1982
Externally publishedYes


  • 5-Aminolevulinic acid
  • Biophotonics
  • Brain tumor
  • Fluorescence-guided surgery
  • Meningioma Optical spectroscopy
  • Protoporphyrin IX

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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