Intraoperative fluorescence diagnostics in surgery of intracranial meningiomas: analysis of 101 cases

Потапов, А А; Goryaynov, S A; Danilov, Gleb; Chelushkin, D M; Охлопков, В. А.; Shimanskiy, V. N.; Beshplav, Sh T; Poshataev, V. K.; Shishkina, L V; Захарова, Н. Е.; Spallone, A; Савельева, Т. А.; Loschenov, Viktor

doi:10.17116/oftalma201882217-29

Cited by 9 publications

(8 citation statements)

References 46 publications

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“…Although high-grade gliomas usually emit high levels of fluorescence, low-grade gliomas show a relatively lower amount of fluorescence after 5-ALA administration 20 . In addition, unlike in high-grade gliomas, PpIX fluorescence is reported to be patchy or lacking in some metastases 21 and central nervous system lymphomas 22 and rarely in meningiomas 23 – 25 as visualized with the blue light of current operating microscopes. Visual PpIX fluorescence in gliomas is not uniform and is typically patchy with areas of high and low fluorescence intensity.…”

Section: Discussionmentioning

confidence: 99%

Optical Characterization of Neurosurgical Operating Microscopes: Quantitative Fluorescence and Assessment of PpIX Photobleaching

Belykh

Miller

Patel

et al. 2018

Sci Rep

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Protoporphyrin IX (PpIX) induced by 5-aminolevulinic acid (5-ALA) is increasingly used as a fluorescent marker for fluorescence-guided resection of malignant gliomas. Understanding how the properties of the excitation light source and PpIX fluorescence interact with the surgical microscope is critical for effective use of the fluorescence-guided tumor resection technique. In this study, we performed a detailed assessment of the intensity of the emitted blue light and white light and the light beam profile of clinical grade operating microscopes used for PpIX visualization. These measurements revealed both recognized fluorescence photobleaching limitations and unrecognized limitations that may alter quantitative observations of PpIX fluorescence obtained with the operating microscope with potential impact on research and clinical uses. We also evaluated the optical properties of a photostable fluorescent standard with an excitation-emission profile similar to PpIX. In addition, we measured the time-dependent dynamics of 5-ALA-induced PpIX fluorescence in an animal glioma model. Finally, we developed a ratiometric method for quantification of the PpIX fluorescence that uses the photostable fluorescent standard to normalize PpIX fluorescence intensity. This method increases accuracy and allows reproducible and direct comparability of the measurements from multiple samples.

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Section: Discussionmentioning

confidence: 99%

Optical Characterization of Neurosurgical Operating Microscopes: Quantitative Fluorescence and Assessment of PpIX Photobleaching

Belykh

Miller

Patel

et al. 2018

Sci Rep

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“…Therefore, residual tumor tissue might remain undetected during meningioma surgery and result in local tumor recurrence. Recently, 5-ALA fluorescence was also described as a promising marker for intraoperative visualization of intracranial meningiomas apart from the main indication of HGG [14,16,20]. In this sense, Kajimoto et al [21] published the first series of 24 meningioma patients in 2007 and observed visible 5-ALA fluorescence during surgery in 83% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, 5-ALA fluorescence was also applied in other tumors than HGG for improved intraoperative identification of anaplastic foci, various tumors in stereotactic biopsies, spinal tumors, brain metastases and meningiomas [8][9][10][11][12][13][14][15]. In meningiomas, visible 5-ALA fluorescence of the tumor bulk during meningioma surgery was reported in a recent series in 77-94% of patients [14][15][16]. According to first observations, 5-ALA fluorescence was found to be useful to visualize also peritumoral tissue such as infiltrated bone flaps and satellite lesions [14].…”

Section: Introductionmentioning

confidence: 99%

High Diagnostic Accuracy of Visible 5‐ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue

Wadiura¹,

Millesi²,

Makolli

et al. 2020

Lasers Surg Med

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Background and Objectives: Complete neurosurgical resection of intracranial meningiomas is essential to avoid residual tumor tissue and thus minimize the risk of tumor recurrence. However, local recurrence of meningiomas is not uncommon mainly due to insufficient intraoperative detection of residual tumor tissue within the tumor bulk or peritumoral tissue such as bone and satellite lesions. Although 5-aminolevulinic acid (5-ALA) induced fluorescence was found to visualize the majority of meningiomas, no comprehensive histopathological assessment of fluorescing samples from the tumor bulk and peritumoral tissue is available. The aim of our study was thus to histopathologically analyze a large series of tissue samples derived from meningioma surgery to assess the positive predictive value (PPV) of visible 5-ALA fluorescence. Study Design/Materials and Methods: In this study, we retrospectively investigated a series of tissue samples with visible 5-ALA fluorescence collected during surgery of intracranial meningiomas from the tumor bulk and peritumoral tissue including the bone flap, dura/dural tail, arachnoidea, adjacent cortex, and satellite lesions. The tumor diagnosis was established according to the World Health Organization (WHO) criteria and all collected fluorescing samples were screened for presence of tumor tissue to calculate the PPV. Results: Altogether, 191 tissue samples with visible 5-ALA fluorescence derived during surgery of 85 meningiomas (63 WHO grade I, 17 WHO grade II, and 5 WHO grade III) were included. In detail, 158 samples from the tumor bulk and 33 specimens from the peritumoral tissue were investigated. According to histopathological analysis, the PPV of 5-ALA fluorescence was significantly higher in samples from the tumor bulk (100%) as compared with peritumoral tissue (73%; P < 0.001). With regard to peritumoral tissue, tumor tissue was present in most fluorescing samples from the satellite lesions (100%), the bone flap (92%), arachnoidea (83%), and dura/dural tail (75%). In contrast, tumor tissue was absent in the majority of samples from fluorescing cortex (six of seven samples; 86%). However, distinct reactive tissue alterations were found in all six tumor-free fluorescing cortex samples and additional vascular proliferation in two cases. Conclusion: In this largest series to date, visible 5-ALA fluorescence is characterized by a high PPV detecting tumor bulk and peritumoral tissue in intracranial meningiomas. Thus, 5-ALA fluorescence supports the neurosurgeon in identifying residual tumor tissue at relevant surgical sites to optimize meningioma surgery and minimize the risk of local recurrence.

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“…The results of 5-ALA application in adults with different types of brain tumors were highlighted in detail in our earlier publications (18, 18, 21, 26). In this study, fluorescence sensitivity in the treatment of high-grade gliomas was 90.2% ( n = 238/264), which corresponded to findings of other authors (22, 32–34).…”

Section: Discussionmentioning

confidence: 77%

“…At the end of 90-ies first data on the potential use of 5-ALA in neurosurgery appeared, with first publications being devoted to malignant gliomas (1, 22). Today, 5-ALA is applied in surgery of different types of brain and spinal cord tumors for both adults and children, including meningiomas (3–7, 26–28), metastasis (8–11), neurocytomas (12), ependymomas (13, 14), medulloblastomas (15).…”

Section: Discussionmentioning

confidence: 99%

Fluorescence Diagnosis in Neurooncology: Retrospective Analysis of 653 Cases

et al. 2019

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Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors.Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5–Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery—with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors.Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy.Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.

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Intraoperative fluorescence diagnostics in surgery of intracranial meningiomas: analysis of 101 cases

Cited by 9 publications

References 46 publications

Optical Characterization of Neurosurgical Operating Microscopes: Quantitative Fluorescence and Assessment of PpIX Photobleaching

Optical Characterization of Neurosurgical Operating Microscopes: Quantitative Fluorescence and Assessment of PpIX Photobleaching

High Diagnostic Accuracy of Visible 5‐ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue

Fluorescence Diagnosis in Neurooncology: Retrospective Analysis of 653 Cases

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