Use of 5-aminolevulinic acid in fluorescence-guided resection of meningioma with high risk of recurrence

Abstract

It has been established that fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is useful in glioma surgery. The authors report on a 65-year-old woman who had a huge atypical left-hemisphere meningioma, which extended into the skull and to the superior sagittal sinus and demonstrated fluorescence in response to administration of 5-ALA. After the tumor was removed, the operative field was observed under the fluorescent mode of a fluorescence surgical microscopy system. Several minute areas of residual tumor tissue were visualized as strong fluorescence behind the vein and sinus, in a part of the hypertrophic dura, and along the edge of the skull. These remnants were completely removed. The authors concluded that fluorescence-guided resection using 5-ALA is useful in cases of atypical meningiomas with a high risk of recurrence.

Laser biospectroscopy and 5-ALA fluorescence navigation as a helpful tool in the meningioma resection

“…Our observations, as well as publications of other authors [18,19], indicate that FN allows to obtain additional information about the infiltrative tumor growth and bone invasion. Therefore, this method may be very useful for surgery in Table 2 Linear correlation between the video fluorescence visually perception and spectroscopic fluorescence recurrence meningioma [19], skull base meningiomas [8], and spinal meningiomas [11].…”

“…However, using 5-ALA in meningioma surgery has been studied only occasionally. Apart from the present research, which was also partly described in a previous publication [22], the most prominent series of meningioma operated on using FN were published by Collucia et al (33 patients) [18] and Kajimoto et al (27 patients) [19]. Both studies reported on convexity, parasagittal, and basal meningiomas of different malignancy degrees.…”

“…Therefore, this method may be very useful for surgery in Table 2 Linear correlation between the video fluorescence visually perception and spectroscopic fluorescence recurrence meningioma [19], skull base meningiomas [8], and spinal meningiomas [11].…”

“…The degree of surgical radicality may be decreased by a number of conditions: (1) the tumor infiltrates the surrounding structures including the dura mater, the bone, and the adjacent brain tissue since the infiltration area, and intact tissue are difficult to differentiate; (2) major vessels and sinuses, folds of the dura, and the cortex sulci may conceal small fragments of the tumor; and (3) secondary nodes of the tumor are sometimes located separately from the main tumor mass [19,[25][26][27][28]29]. FN is feasible as a technique that can help overcome these difficulties.…”

“…At the same time, no statistically significant effect on the overall survival rate was identified. Nevertheless, this technology has attracted an increased attention of neurosurgeons resulting in more reports on FN, as well as the application of this method for other central nervous system tumors [4,[7][8][9][10][11][12][13][14][15][16] including intracranial meningiomas [16][17][18][19][20]. However, the assessment of FN's sensitivity and specificity was not demonstrated clearly and in particular, no comparison was made between the data obtained from visible fluorescence, and the data obtained from laser biospectroscopy in meningiomas of different World Health Organization (WHO) grades.…”