gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Usefulness of 5-ALA (Gliolan®) derived PPX fluorescence for demonstrating the true extent of atypical meningiomas. A report on two compassionate use cases

Meeting Abstract

  • E. Wilbers - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • B. Fischer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • L. Lemcke - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • C. Ewelt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • J. Wölfer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster
  • W. Stummer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 073

DOI: 10.3205/12dgnc460, URN: urn:nbn:de:0183-12dgnc4605

Published: June 4, 2012

© 2012 Wilbers et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: The use of 5-aminolevulinic acid (5-ALA) is well established for high grade glioma resections. Meningiomas have also been observed to accumulate fluorescence in response to 5-ALA. Atypical meningiomas tend to recur, despite radiotherapy and are difficult to control surgically, possibly because the true extent of infiltration of adjacent tissue is not distinguishable. We tested the usefulness of 5-ALA for distinguishing residual infiltration in two cases of atypical meningiomas.

Methods: A 47-year-old woman presented with a recurrence of an atypical meningioma (WHO grade II) of the left wing of the sphenoid bone after initial resection two years previously (June 2009). The tumor recurred in November 2011 was operated on using 5-ALA (Gliolan®). Fuorescence was visualized using a Zeiss Pentero Microscope. The second case was a 21-year-old woman with a recurrence of an parasagital postcentral atypical meningioma (WHO grade II) of the right hemisphere. The initial tumor was resected five years before (April 2006) with consecutive radiotherapy. The tumor recurred 2011 and was resected using 5-ALA.

Results: In both cases macroscopic fluorescence was observed in the gross tumor. However, fluorescence was also found in adjacent dura not clearly distinguished as tumor under white light. Furthermore, small areas of distinct fluorescence were observed within the arachnoid of the adjacent cortex which was removed. Histologically, fluorescence corresponded to tumor infiltration.

Conclusions: 5-ALA (Gliolan®) derived tumor fluorescence appears to be useful for distinguishing areas of residual infiltration in patients suffering recurrences of atypical meningiomas. Thus, this tool appears to bear potential for enhancing surgery and possibly prognosis in these patients.