# Maximal Intraoperative 5-Aminolevulinic Acid Fluorescence During Surgical Resection of Multiple Lesions in Multifocal Glioblastoma to Achieve Greater Extent of Resection: A Case Report

## TL;DR

A 79-year-old patient with multifocal glioblastoma had successful surgery using 5-aminolevulinic acid fluorescence to guide removal of multiple brain lesions.

## Contribution

Demonstrates the feasibility and safety of using 5-aminolevulinic acid fluorescence for resecting multiple glioblastoma lesions during a single surgery.

## Key findings

- Intraoperative 5-aminolevulinic acid fluorescence successfully guided resection of multiple lesions in a multifocal glioblastoma case.
- The procedure was performed safely without major complications.
- This approach may improve the extent of resection in multifocal glioblastoma.

## Abstract

Multifocal glioblastoma represents a therapeutic challenge with conflicting evidence on treatment, though it appears that the extent of resection also plays an important role in this disease. The use of 5-aminolevulinic acid has been shown to improve the extent of resection in high-grade gliomas; however, there is little information about its use in multifocal glioblastoma. We present the case of a 79-year-old patient with distant glial lesions who underwent surgery for the resection of a right temporal and a right occipital lesion at the same surgical time. Intraoperative findings and postsurgical events are described in this report. This case shows that resection of multiple lesions in a patient with multifocal glioblastoma using intraoperative 5-aminolevulinic acid fluorescence is feasible and safe.