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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.

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a, b MRI showing the fourth recurrence of a right sided occipital falx meningioma with tumor invasion of the skin; c, d intradural tumor part showing bright 5-ALA fluorescence; e, f subcutaneous tumor tissue does not show a fluorescent signal under violet-blue light 207 × 112 mm (72 × 72 DPI)
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Fig2: a, b MRI showing the fourth recurrence of a right sided occipital falx meningioma with tumor invasion of the skin; c, d intradural tumor part showing bright 5-ALA fluorescence; e, f subcutaneous tumor tissue does not show a fluorescent signal under violet-blue light 207 × 112 mm (72 × 72 DPI)

Mentions: A 65-year-old female with a subtotal resection of an occipital falx meningioma (WHO grade I) in 1986 underwent re-craniotomy and radiotherapy treatment (60 Gy) in 2004 at our institution. Histopathological examination revealed an atypical meningioma (WHO grade II). In 2008, re-craniotomy was performed following tumor relapse (WHO grade II). Due to a next recurrence, 5-ALA-assisted surgery was performed in 2010, where the intracranial tumor was fluorescence-negative (meningioma WHO grade II). The next year, the tumor recurred, with an extension into the extracranial subcutaneous tissues. The intracranial part was compatible with a WHO grade II meningioma, while the extracranial tumor extension was consistent with a WHO grade III meningioma. 5-ALA-assisted resection showed no fluorescence of the extracranial tumor (WHO III), whereas the intracranial part (WHO II) showed bright fluorescence (see Fig. 2).Fig. 2


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 fourth recurrence of a right sided occipital falx meningioma with tumor invasion of the skin; c, d intradural tumor part showing bright 5-ALA fluorescence; e, f subcutaneous tumor tissue does not show a fluorescent signal under violet-blue light 207 × 112 mm (72 × 72 DPI)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: a, b MRI showing the fourth recurrence of a right sided occipital falx meningioma with tumor invasion of the skin; c, d intradural tumor part showing bright 5-ALA fluorescence; e, f subcutaneous tumor tissue does not show a fluorescent signal under violet-blue light 207 × 112 mm (72 × 72 DPI)
Mentions: A 65-year-old female with a subtotal resection of an occipital falx meningioma (WHO grade I) in 1986 underwent re-craniotomy and radiotherapy treatment (60 Gy) in 2004 at our institution. Histopathological examination revealed an atypical meningioma (WHO grade II). In 2008, re-craniotomy was performed following tumor relapse (WHO grade II). Due to a next recurrence, 5-ALA-assisted surgery was performed in 2010, where the intracranial tumor was fluorescence-negative (meningioma WHO grade II). The next year, the tumor recurred, with an extension into the extracranial subcutaneous tissues. The intracranial part was compatible with a WHO grade II meningioma, while the extracranial tumor extension was consistent with a WHO grade III meningioma. 5-ALA-assisted resection showed no fluorescence of the extracranial tumor (WHO III), whereas the intracranial part (WHO II) showed bright fluorescence (see Fig. 2).Fig. 2

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