gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

5-ALA fluorescence in a cerebral infarction mimicking high-grade glioma – a case report

Meeting Abstract

  • Felix Behling - Abteilung für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Antje Bornemann - Abteilung für Neuropathologie, Universitätsklinikum Tübingen, Germany
  • Florian Hennersdorf - Abteilung für Neuroradiologie, Universitätsklinikum Tübingen, Germany
  • Marcos Tatagiba - Abteilung für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Marco Skardelly - Abteilung für Neurochirurgie, Universitätsklinikum Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 098

doi: 10.3205/16dgnc473, urn:nbn:de:0183-16dgnc4732

Veröffentlicht: 8. Juni 2016

© 2016 Behling et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: 5-aminolevulinic acid (5-ALA) has become an integral part of neurosurgical treatment of malignant glioma. Over time, several other tumor entities have been identified to metabolize 5-ALA as well and presented with a similar fluorescence patterns during surgical resection.

Method: We present a case of a woman with a cerebral lesion with typical radiological features of malignant glioma. After 5-ALA fluorescence guided surgery the lesion turned out to be an ischemic infarction.

Results: The intraoperative frozen section was inconclusive. It showed necrosis with accompanying astrocytosis and pigment-laden macrophages. No viable tumor tissue could be identified. The definite histopathological diagnosis revealed stage II of a cerebral infarction. This is the first description of intraoperative fluorescence activity of postischemic cerebral tissue. Follow-up scans were unremarkable.

Conclusions: This unusual case underlines the importance of radiographic differential diagnoses of malignant glioma. Although, transient neurological deficits can be attributed to tumor growth and edema when encountering a ring-enhancing lesion, cerebral ischemia should be considered as a possible cause as well. The intraoperative fluorescence of a cerebral infarction may be due to inflammatory reactions and cannot be fully explained. Thus the role of 5-ALA in postischemic brain tissue needs further investigation.