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Fluorescence-guided resection in bone and soft tissue infiltrating meningiomas.
- Source :
-
Acta neurochirurgica [Acta Neurochir (Wien)] 2020 Mar; Vol. 162 (3), pp. 605-611. Date of Electronic Publication: 2019 Dec 24. - Publication Year :
- 2020
-
Abstract
- Background: Bone infiltration of the tumour is common in meningioma surgery. This may also affect patients without indicative signs of bone infiltration on preoperative imaging. Unrecognized bone invasion may lead to higher recurrence rates. 5-ALA fluorescence-guided resection (5-ALA-fg) could be a promising tool to help recognize possible bone invasion and/or tumour remnants. However, there is still little data about 5-ALA-fg resection in bone and soft tissue infiltrating meningiomas.<br />Methods: We performed a retrospective study of 11 patients who were operated with the aid of 5-ALA due to bone and soft tissue infiltrating meningiomas at the University Hospital of St. Poelten between 2013 and 2019.<br />Results: Strong and homogeneous fluorescence of the meningioma was observed in 9 cases (81.8%) and vague and heterogeneous fluorescence in 2 cases (18.2%). Hyperostosis on computerized tomography was evident in 3 of 6 cases (50%) and bone infiltration was visible in preoperative magnetic resonance imaging in 7 of 11 patients (63.6%). All eleven patients showed positive fluorescence of the bone infiltrating part. In all 7 cases where tissue could be collected, histopathological testing verified tumour infiltration (100%). There was also fluorescence of the periosteum in 3 cases and histopathological testing verified tumour infiltration in 100%.<br />Conclusion: There is growing evidence that 5-ALA-fg resection can help to identify bone infiltration in meningioma surgery. Therefore, it may help to improve extent of resection. However, further studies are necessary to investigate the rate of false-negative fluorescence and its effect on progression free survival. If 5-ALA-fg resection of meningioma is performed, the attending surgeon should also consider investigating the adjacent periosteum under blue light for detection of possible fluorescence.
- Subjects :
- Adult
Aged
Aminolevulinic Acid
Bone Neoplasms etiology
Bone Neoplasms secondary
Female
Fluorescence
Humans
Hyperostosis diagnostic imaging
Hyperostosis etiology
Intraoperative Complications etiology
Male
Meningeal Neoplasms pathology
Meningioma pathology
Middle Aged
Neurosurgical Procedures adverse effects
Optical Imaging methods
Soft Tissue Neoplasms etiology
Soft Tissue Neoplasms secondary
Surgery, Computer-Assisted adverse effects
Bone Neoplasms diagnostic imaging
Intraoperative Complications diagnostic imaging
Meningeal Neoplasms surgery
Meningioma surgery
Neurosurgical Procedures methods
Soft Tissue Neoplasms diagnostic imaging
Surgery, Computer-Assisted methods
Subjects
Details
- Language :
- English
- ISSN :
- 0942-0940
- Volume :
- 162
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Acta neurochirurgica
- Publication Type :
- Academic Journal
- Accession number :
- 31873793
- Full Text :
- https://doi.org/10.1007/s00701-019-04179-7