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The current status of 5-ALA fluorescence-guided resection of intracranial meningiomas-a critical review.

Motekallemi A, Jeltema HR, Metzemaekers JD, van Dam GM, Crane LM, Groen RJ - Neurosurg Rev (2015)

Bottom Line: PubMed was used as the database for search tasks.Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility.However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder.

View Article: PubMed Central - PubMed

Affiliation: University of Groningen, Groningen, The Netherlands.

ABSTRACT
Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. In the present paper, we review the existing literature about the application of 5-ALA as an intraoperative tool for the resection of intracranial meningiomas. PubMed was used as the database for search tasks. We included articles published in English without limitations regarding publication date. Tumor fluorescence can occur in benign meningiomas (WHO grade I) as well as in WHO grade II and WHO grade III meningiomas. Most of the reviewed studies report fluorescence of the main tumor mass with high sensitivity and specificity. However, different parts of the same tumor can present with a different fluorescent pattern (heterogenic fluorescence). Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility. However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.

No MeSH data available.


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a, b MRI showing the third recurrence of a parasagittal meningioma with two prominent noduli involving the skin; c, d the intradural tumor part shows bright 5-ALA fluorescence; e, f the skin involving tumor noduli also show bright 5-ALA fluorescence 210 × 111 mm (72 × 72 DPI)
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Fig1: a, b MRI showing the third recurrence of a parasagittal meningioma with two prominent noduli involving the skin; c, d the intradural tumor part shows bright 5-ALA fluorescence; e, f the skin involving tumor noduli also show bright 5-ALA fluorescence 210 × 111 mm (72 × 72 DPI)

Mentions: A 46-year-old male with a parietal meningioma (WHO grade I) underwent his first craniotomy in 2002. Due to a regrowth after 6 years (which at that time it appeared to be a WHO grade II meningioma), re-craniotomy and stereotactic radiosurgery (54 Gy) were performed. In the same year, routine follow-up showed regrowth with the now also involvement of the cranium. Histopathological analysis revealed an anaplastic meningioma (WHO grade III). In 2009, the tumor recurred, showing extracranial (cutaneous) and intracranial infiltration. Therefore, 5-ALA-assisted tumor resection was accomplished. Both intra- and extracranial tumor parts (both WHO grade III) showed bright fluorescence (see Fig. 1). The patient was additionally treated with stereotactic radiosurgery (20 Gy). In 2011 and 2012, two re-craniotomies were performed because of tumor growth, not far from the original operative area, both resulting into the resection of atypical meningiomas (WHO grade II).Fig. 1


The current status of 5-ALA fluorescence-guided resection of intracranial meningiomas-a critical review.

Motekallemi A, Jeltema HR, Metzemaekers JD, van Dam GM, Crane LM, Groen RJ - Neurosurg Rev (2015)

a, b MRI showing the third recurrence of a parasagittal meningioma with two prominent noduli involving the skin; c, d the intradural tumor part shows bright 5-ALA fluorescence; e, f the skin involving tumor noduli also show bright 5-ALA fluorescence 210 × 111 mm (72 × 72 DPI)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4561998&req=5

Fig1: a, b MRI showing the third recurrence of a parasagittal meningioma with two prominent noduli involving the skin; c, d the intradural tumor part shows bright 5-ALA fluorescence; e, f the skin involving tumor noduli also show bright 5-ALA fluorescence 210 × 111 mm (72 × 72 DPI)
Mentions: A 46-year-old male with a parietal meningioma (WHO grade I) underwent his first craniotomy in 2002. Due to a regrowth after 6 years (which at that time it appeared to be a WHO grade II meningioma), re-craniotomy and stereotactic radiosurgery (54 Gy) were performed. In the same year, routine follow-up showed regrowth with the now also involvement of the cranium. Histopathological analysis revealed an anaplastic meningioma (WHO grade III). In 2009, the tumor recurred, showing extracranial (cutaneous) and intracranial infiltration. Therefore, 5-ALA-assisted tumor resection was accomplished. Both intra- and extracranial tumor parts (both WHO grade III) showed bright fluorescence (see Fig. 1). The patient was additionally treated with stereotactic radiosurgery (20 Gy). In 2011 and 2012, two re-craniotomies were performed because of tumor growth, not far from the original operative area, both resulting into the resection of atypical meningiomas (WHO grade II).Fig. 1

Bottom Line: PubMed was used as the database for search tasks.Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility.However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder.

View Article: PubMed Central - PubMed

Affiliation: University of Groningen, Groningen, The Netherlands.

ABSTRACT
Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. In the present paper, we review the existing literature about the application of 5-ALA as an intraoperative tool for the resection of intracranial meningiomas. PubMed was used as the database for search tasks. We included articles published in English without limitations regarding publication date. Tumor fluorescence can occur in benign meningiomas (WHO grade I) as well as in WHO grade II and WHO grade III meningiomas. Most of the reviewed studies report fluorescence of the main tumor mass with high sensitivity and specificity. However, different parts of the same tumor can present with a different fluorescent pattern (heterogenic fluorescence). Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility. However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.

No MeSH data available.


Related in: MedlinePlus