Safety Profile of 5-Aminolevulinic Acid as a Surgical Adjunct in Clinical Practice: A Review of 207 Cases From 2008 to 2013
Honorato-Cia C (1), Martinez-Simón A, Cacho-Asenjo E, Guillén-Grima F, Tejada-Solís S, Diez-Valle R.
(1) Departments of *Anesthesiology and Critical Care †Epidemiology and Preventive Medicine ‡Neurosurgery, University Hospital of Navarra, Pamplona, Spain.
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.
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.
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.
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.
CITATION J Neurosurg Anesthesiol. 2015 Oct;27(4):304-9. doi: 10.1097/ANA.0000000000000172