Artikel
The value of visible 5-ALA induced PpIX fluorescence during surgery for spinal ependymomas
Die Bedeutung von 5-ALA induzierter PpIX-Fluoreszenz während derchirurgischen Resektion spinaler Ependymome
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Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Gross total resection (GTR) is the treatment of choice in the majority of cases suffering from spinal ependymomas. The extent of resection is considered the most important factor for patient prognosis and the risk of recurrence. However, incomplete resection is not uncommon leading to an increased risk of tumor recurrence. One important aspect leading to such an incomplete resection is insufficient visualization of tumor tissue during surgery. Therefore, we investigated the value of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence in a consecutive series of spinal ependymomas.
Methods: Since 2009, 5-ALA was administered in a total of 31 patients with spinal ependymomas. A conventional white-light microsurgical resection of the tumor was performed in all cases. In addition to this standard procedure, the PpIX fluorescence status of each tumor was evaluated during surgery repeatedly using a modified neurosurgical microscope. In intramedullary tumors, if GTR was feasible and assumed, the resection cavity was investigated for potential residual fluorescing foci.
Results: In all patients, the application of 5-ALA was feasible and no side effects occurred. PpIX fluorescence was observed in the majority of spinal ependymomas (n=25, 81%). In contrast, no fluorescence was noted the remaining 6 patients (19%). After assumed GTR in intramedullary tumors (n=15), residual fluorescing foci within the resection cavity could be detected in 5 cases (33%).
Conclusion: 5-ALA is a promising marker for intraoperative visualization of spinal ependymomas with the majority of cases showing visible PpIX fluorescence. Residual fluorescing foci could be identified in 33% of intramedullary tumors after assumed GTR under conventional white-light. Therefore, 5-ALA induced PpIX fluorescence may be useful in increasing the extent of resection in intramedullary ependymomas and thus in future may reduce the risk of recurrence.