Mayfield Neurosurgeons Debut Fluorescence-Guided Brain Cancer Technology

CINCINNATI - Neurosurgeons at Mayfield Brain & Spine are among the first in the nation to utilize 5-ALA fluorescence-guided neurosurgery in the treatment of patients with brain cancer. Mayfield specialists began using the technology at Good Samaritan Hospital last week and are preparing for implementation at The Jewish Hospital-Mercy Health.

The technology causes malignant brain cells to luminesce, making them visible to the surgeon and easier to remove. It involves the use of 5-aminolevulinic acid (5-ALA), a drug, and a special microscope. It is used in the treatment of glioblastoma, an aggressive form of malignant glioma brain cancer that is diagnosed in approximately 23,000 Americans each year.

Glioblastoma, unlike a solid tumor, is a diffuse and infiltrative cancer that can present like a milk splatter. When removing it, surgeons face the daunting challenge of differentiating and capturing cancer cells that extend their tentacles into healthy tissue. The 5-ALA technology, approved by the Food and Drug Administration for brain surgery in June 2017, causes individual cells to turn a luminescent pink, allowing for precise visualization and removal. It is being used by approximately 50 hospitals nationwide.

"Tumor fluorescence is able to be visualized in surgery using a special fluorescence filter on a microscope," said Christopher McPherson, MD, a Mayfield neurosurgeon and Site Director for Neurosurgery at Good Samaritan Hospital. "This allows for identification of residual tumor and improves our ability to obtain a more complete resection.

"Studies have shown that more extensive tumor resection improves survival in glioblastoma. In the specific case on Friday, additional tumor beyond the edge of what I would have identified as tumor was identified by the fluorescence in surgery and was resected, allowing for a more complete resection."

Andrew Ringer, MD, Chairman of Mayfield Brain & Spine and Chief of Neurosciences for TriHealth, hailed the development at Good Samaritan, which last fall became the first hospital in the Midwest and the third in the country to earn The Joint Commission's Gold Seal of Approval® for Brain Tumor Certification. The Gold Seal of Approval® is a symbol of national quality that reflects an organization's commitment to providing safe and effective patient care.

"Fluorescence-guided surgery provides a significant benefit to the patient in that it improves the completeness of resection, a known predictor of outcomes," Dr. Ringer said.

He said that the technology's adoption by Mayfield neurosurgeons at two major hospital systems "is proof that where Mayfield goes, we improve the quality. Significantly."

The drug 5-ALA, marketed as Gleolan™, is given orally 3 to 4 hours prior to surgery. The main side effect is light sensitivity for 48 hours following surgery, Dr. McPherson said, and patients must be kept out of full light and direct sunlight.

Mayfield's Vincent DiNapoli, MD, PhD, Director of the Brain Tumor Center at The Jewish Hospital, will be using the technology imminently. He cautioned, however, that despite the promise of improved outcomes offered by 5-ALA technology, it is unlikely to provide a final cure for glioblastoma.

"A cure, when we finally see it, will emerge from the immunotherapy realm," Dr. DiNapoli said. "We will see something that will come out of the body and attack the cells and kill them off. We know that just taking the tumor out will not do the job in the long run. Years ago, when surgeons removed whole lobes of the brain, resecting even margins around the tumor, the tumor still came back.

"So even though clean removal of the tumor helps survivorship and prognosis, we know that this cancer is not a local phenomenon. This disease process is something different. Something in the immune system in the brain is allowing these tumors to occur."

Published studies have shown that 5-ALA fluorescence-guided surgery has resulted in a higher rate of complete tumor removal than previous visualization technologies, and it is being adopted by leading neurosurgical practices around the world.

Gleolan is marketed by NX Development Corp., of Lexington, Kentucky.

Mayfield Brain & Spine is the full-service patient care provider of the Mayfield Clinic, one of the nation's leading physician organizations for neurosurgical treatment, education, and research. With more than 20 specialists in neurosurgery, interventional neuroradiology, physical medicine and rehabilitation, pain management, and physical therapy, Mayfield Brain & Spine treats 25,000 patients from more than 30 states in a typical year. Mayfield physicians specialize in the treatment of back and neck pain, sciatica, Parkinson's disease, essential tremor, NPH, epilepsy, brain and spinal tumors, stroke, moyamoya, brain aneurysms, Chiari malformation, scoliosis, kyphosis, facial pain, facial twitch, trauma, concussion, spinal cord injury, and carpal tunnel. As leading innovators in their field, Mayfield physicians have pioneered surgical procedures and instrumentation that have revolutionized the medical art of neurosurgery for spinal diseases and disorders, brain tumors, and neurovascular diseases and disorders.