Pharmaceutical equivalent 5-aminolevulinic acid fluorescence guided resection of central nervous system tumors: feasibility, safeness and cost-benefit considerations.

PURPOSE: 5-aminolevulinic acid (5-ALA) fluorescence-guided resection (FGR) has been an essential tool in the 'standard of care' of malignant gliomas. Over the last two decades, its indications have been extended to other neoplasms, such as metastases and meningiomas. However, its availability and cost-benefit still pose a challenge for widespread use. The present article reports a retrospective series of 707 cases of central nervous system (CNS) tumors submitted to FGR with pharmacological equivalent 5-ALA and discusses financial implications, feasibility and safeness. METHODS: From December 2015 to February 2024, a retrospective single institution series of 707 cases of 5-ALA FGR were analyzed. Age, gender, 5-ALA dosage, intraoperative fluorescence finding, diagnosis and adverse effects were recorded. Financial impact in the surgical treatment cost were also reported. RESULTS: there was an additional cost estimated in $300 dollars for each case, increasing from 2,37 to 3,28% of the total hospitalization cost. There were 19 (2,69%) cases of asymptomatic photosensitive reaction and 2 (0,28%) cases of photosensitive reaction requiring symptomatic treatment. 1 (0,14%) patient had a cutaneous rash sustained for up to 10 days. No other complications related to the method were evident. In 3 (0,42%) cases of patients with intracranial hypertension, there was vomiting after administration. CONCLUSION: FGR with pharmacological equivalent 5-ALA can be considered safe and efficient and incorporates a small increase in hospital expenses. It constitutes a reliable solution in avoiding prohibitive costs worldwide, especially in countries where commercial 5-ALA is unavailable.

Síndrome de Moebius: revisão de literatura e relato de caso / Moebius syndrome: review of the literature and case report

A Síndrome de Moebius (SM) é distúrbio neurológico raro e não-progressivo com paralisia dos VI e VII pares cranianos associada a outras manifestações. A incidência é de 1:50.000 nascimentos. Este trabalho apresenta um caso de SM do Serviço de Neurologia do HUEC. Descrição do caso: mulher, 38 anos, branca, primogênita, gestação indesejada, tentativa de aborto com substância desconhecida. Relata 3 episódios de convulsão não investigados ou tratados. Exame físico: BEG, IMC 21, hipomímica facial, lábios entreabertos, sialorreia, arcada dentária alterada, palato ogival, língua geográfica e micrognatia. No exame neurológico: 20 pontos no mini exame do estado mental, paralisia facial bilateral, convergência e nistagmo de acomodação ambos à esquerda, limitação de campo visual com diminuição da acuidade visual (20/40 da tabela de Snellen), sem reflexo corneano bilateral, com sinal de Babinski bilateral, os testes index dedo e index nariz e oposição dos dedos se demonstraram alterados à esquerda

Moebius Syndrome (MS) is a rare and non-progressive neurological disorder with paralysis of VI and VII cranial nerves associated with other manifestations. The incidence is 1:50,000 births. This paper presents a case of MS from the HUEC Neurology Service. Case Description: woman, 38 years old, white, first-born, unwanted gestation, abortion attempt with unknown substance. Reports 3 seizure episodes not investigated or treated. Physical examination: Good General Condition, BMI 21, facial hypomimicry, parted lips, sialorrhea, altered dental arch, oval palate, geographic tongue and micrognathia. Neurological exam: 20 points in the MEEM, bilateral facial mimic paralysis, convergence and nystagmus of accommodation both left, visual field limitation with decreased visual acuity (20/40 of the Snellen table), without bilateral corneal reflex, with bilateral Babinski's sign, finger-to-nose and finger opposition test were shown altered on the left