Glioma, a primary brain tumor, that begins in the glial cells surrounding and supporting nerve cells is the most common type of adult brain tumor. It comprises 78% of malignant brain tumors in adults and is also the most common pediatric solid tumor, accounting for about 53% of tumors in children younger than 14 years. Despite modern technology, surgeons find it difficult to determine if they have removed the entire brain tumor. Glioma treatment can be particularly challenging as the tumors usually have “finger-like” projections extending into various parts of the brain. Now, a one-of-a-kind optical imaging agent illuminates glioma, making it easier for neurosurgeons to see the tumor tissue to be removed. The enhanced visualization enables neurosurgeons to identify and remove as much of the cancer as possible, thus improving patient outcomes.

Gleolan from Medexus Pharmaceuticals (Mississauga, ON, USA) is the first and only FDA-approved optical imaging agent for use during fluorescence-guided surgery (FGS) in patients with high grade gliomas, which means the tumor is suspected World Health Organization Grades III or IV on preoperative imaging, as an adjunct for the visualization of malignant tissue during surgery. Gleolan is the only FDA-approved product that highlights a glioma tumor and surrounding cancer tissue in a bright hue.

Gleolan is an oral solution that contains aminolevulinic acid hydrochloride (ALA HCl) and is given to the patient to drink three hours (between two to four hours) before receiving anesthesia for the surgery. With the proper dosage of Gleolan administered during surgery, the neurosurgeon can view the brain through special blue light filters on a surgical microscope. Under the blue light, Gleolan helps the tumor “fluoresce” or glow a red-violet color. Since non-cancerous brain cells are unlikely to glow when using the blue light filters, the neurosurgeons can better distinguish the tumor from normal tissue, allowing them to remove more of the tumor tissue.

“When surgically resecting a brain tumor, our aim is always to remove it completely,” said Adam Robin, M.D., neurosurgeon at Henry Ford’s Hermelin Brain Tumor Center (HBTC), who performed the first brain surgery using Gleolan at Henry Ford West Bloomfield Hospital. “When using this imaging agent, we perform the tumor resection procedure under a special blue light, which causes the tumor cells to be bright pink or magenta in color. This visual aid enhances our ability to identify tumor cells that otherwise may have been hidden or more challenging to identify.” 

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