In brain tumour surgery, precision is not just about removing what is visible; it is about knowing where the tumour ends and healthy, functioning brain begins. This is particularly challenging when a tumour lies close to areas that control essential functions such as movement and sensation.
For such demanding surgeries, there is a constant need for greater accuracy, which has driven the development of newer surgical adjuncts that can give neurosurgeons information beyond what the naked eye can provide.
What can be done?
One such technology that is of immense help to experts is 5-aminolevulinic acid (5-ALA) fluorescence-guided surgery, which is helping surgeons better visualise tumour tissue during an operation.
How does it work?
5-ALA is a compound that, when administered before surgery, is preferentially taken up by certain brain tumour cells. When viewed under a specialized BLUE light fluorescence in the Carl Zeiss KINEVO 900 operating microscope, these tumour cells fluoresce, standing out clearly from surrounding normal brain tissue.
This advanced visualisation serves as an important intraoperative aid during surgery, particularly at the tumour margins, supporting the surgical team in their efforts to identify and remove tumour tissue as precisely as possible.
This technology is especially important when tumours are located in eloquent areas of the brain, regions responsible for vital functions. In these situations, surgery involves a delicate balance between removing as much tumour as possible and protecting the surrounding healthy tissue.
Manipal Hospital Electronics City is leveraging these advanced adjuncts including fluorescence-guided surgery, neuronavigation and neuromonitoring, to support this and enable a more informed approach to complex brain tumour surgery.
“Given the critical location, the surgical team used multiple adjuncts, neuronavigation, 5-ALA fluorescence-guided surgery and neuromonitoring, to guide the procedure. These technologies helped the team remove the majority of the tumour while navigating the surrounding functional brain tissue. The patient had a favourable molecular analysis and is now planned for chemotherapy and radiotherapy,” explains Dr Shyam Duvuru, Senior Consultant - Neurosurgery, Manipal Hospital Electronics City.
For patients facing complex brain tumours, these advances represent an important step towards more informed, precise and safer surgery, where every available tool can contribute to the best possible outcome.
