Laurel Valente

Background: 5-Aminolevulinic acid (5-ALA) serves as a precursor in the heme biosynthesis pathway, resulting in the selective accumulation of protoporphyrin IX (PpIX) within glioma cells. This property facilitates fluorescence-guided resection (FGR) in high-grade gliomas (HGGs), enhancing surgical precision and oncological results. Nonetheless, its clinical implementation is restricted by factors such as accessibility, cost, and technical limitations. Methods: A systematic review of PubMed literature (2019–2024) was conducted to assess the efficacy of 5-ALA in HGG surgery compared to conventional white light microscopy. Studies focusing on non-neurosurgical applications, pediatric populations, and non-HGG indications were excluded. Results: Nineteen articles met the criteria. Recent studies indicate that 5-ALA-guided resection significantly enhances gross total resection (GTR) rates compared to white light surgery (75.4% vs. 54.3%, p < 0.001). Patients receiving 5-ALA-assisted resection exhibit enhanced progression-free survival (PFS) at 6 months (median 8.1 months compared to 5.4 months, p = 0.002) and overall survival (OS) (median 15.2 months versus 12.3 months, p = 0.008). The necessity for specialized neurosurgical microscopes equipped with blue light filters restricts accessibility, especially in low-resource environments. Recent advancements in fluorescence-enhancing technologies, particularly loupe-based systems, have demonstrated increases in fluorescence intensity by up to tenfold through direct emission. Sodium fluorescein, originally designed for ophthalmological use, has been adapted for enhancing contrast in intracranial tumors; however, its non-specific binding to serum albumin restricts its accuracy in glioma resection. Conclusions: Recent publications demonstrate that 5-ALA fluorescence-guided surgery significantly improves gross total resection rates and survival outcomes in patients with high-grade gliomas. Although it offers clinical advantages, cost and equipment constraints continue to pose substantial obstacles to broad implementation. Additional research is required to enhance fluorescence-guided techniques and increase accessibility in resource-constrained environments.

Background: Hypothalamic gliomas, though rare, present significant challenges in neuro-oncology due to their critical location and high morbidity risk. Pilocytic astrocytoma is the most common subtype, requiring a delicate balance between tumor control and preservation of neurological function. This study explores radiosurgery as a viable treatment option for hypothalamic gliomas, with a focus on low-grade lesions. Methods: A comprehensive literature review was conducted using the PubMed database to compare the outcomes of surgical and non-surgical interventions for hypothalamic gliomas. The purpose of case report and clinical guidelines is to present a case report and critically compare its outcomes with the data identified in the literature. We report the case of a 25-year-old male presenting with hypernatremia, diabetes insipidus, and altered mental status. Imaging revealed a hypothalamic lesion consistent clinically with a low-grade astrocytoma. Given the tumor’s proximity to critical neurovascular structures, gamma knife radiosurgery was chosen as the intervention. Post treatment, tumor reduction and neurological improvement were observed and documented. Results: The case demonstrated a significant decrease in tumor size and resolution of neurological symptoms post radiosurgery. The management of hypothalamic gliomas remains contentious due to the complex anatomy of the hypothalamus. While surgical resection remains common, it carries a high risk of morbidity. Radiosurgery offers a minimally invasive alternative, effectively controlling tumor growth while reducing neurological risk. The favorable outcomes in our case, supported by the literature, highlight the efficacy of radiosurgery, particularly for low-grade astrocytomas. Conclusions: Gamma knife radiosurgery presents a promising alternative to conventional surgery for hypothalamic gliomas, particularly low-grade lesions such as pilocytic astrocytomas. The reduction in surgical risk and positive clinical outcomes make radiosurgery a valuable tool in the management of these challenging tumors.