Longer survival of a patient with glioblastoma resected with 5-aminolevulinic acid (5-ALA)-guided surgery and foreign body reaction to polyglycolic acid (PGA) suture

In recent years, there is a growing evidence that using 5-aminolevulinic acid (5-ALA)-guided resection of a cerebral glioblastoma, associated with chemoradiotherapy determine a prolonged survival of these patients, even though this period do not exceed 15 months. 5-ALA is a natural biochemical precursor of heme that is metabolized to fluorescent porphyrins, particularly protoporphyrin IX (PPIX) and no foreign reaction were noted until now. However, foreign body reaction developing in neurosurgery is documented in a few number of cases to suture material, surgical hemostatic material, or surgical glove starch, but up to now we could not find any article about granulomatous inflammation to polyglycolic acid (PGA) suture after brain tumor resection. Here we present a case of a delayed foreign body granuloma to PGA suture diagnosed after 10 months following fluorescence-guided surgery with 5-ALA for resection of a cerebral glioblastoma that was difficult to diagnosis both clinically and on magnetic resonance imaging (MRI). Moreover, the survival time was longer. We correlate the appearance of foreign body granuloma with the patient's persistent pre- and postoperative lymphocytosis. We also suggest that the chronic inflammation inhibited the proliferation of any tumoral cells which could remain in the tumor bed because we did not noticed on serial MRI scans a rapidly tumor growth during the first 10 months after the initial surgery as we have expected to be for a glioblastoma.