Awake resection of recurrent astroblastoma with intraoperative 5-ALA–induced fluorescence: illustrative case

Anthony Price, Sean O’leary, Kseniia Malkova, Preston D’souza, Christian Ogasawara, Michelle M. Felicella, Patrick J. Karas

Research output: Contribution to journalArticlepeer-review


BACKGROUND Astroblastoma is a rare neoplasm characterized as a circumscribed glial neoplasm most often arising in the frontoparietal cerebral hemispheres in older children. OBSERVATIONS We report an intriguing case of an astroblastoma recurrence 21 years after gross-total resection and radiation. A 32-year-old right-handed female presented to the emergency department for a generalized tonic-clonic seizure. She had a history of bipolar disorder, intractable migraines, and prior seizures linked to an astroblastoma previously resected three times. Magnetic resonance imaging on the current visit showed growth of the recurrent lesion to a 3.8-cm maximal diameter. Left-sided awake craniotomy was performed to remove the tumor while using speech mapping and 5-aminolevulinic acid (5-ALA). Targeted next-generation sequencing of the tumor revealed in-frame MN1::BEND2 fusion transcripts. LESSONS We found that 5-ALA can be used in astroblastoma patients to assist in gross-total resection, which is important for long-term survival. Our astroblastoma case demonstrated classic astroblastoma morphology, with typical perivascular astroblastic rosettes, and was brightly fluorescent after 5-ALA administration.

Original languageEnglish (US)
Article numberCASE23526
JournalJournal of Neurosurgery: Case Lessons
Issue number18
StatePublished - Oct 2023


  • 5-ALA
  • 5-aminolevulinic acid
  • astroblastoma
  • awake resection
  • recurrent astroblastoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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