Artikel
Gamma probe-assisted removal of intracranial meningioma – a feasibility study
Gammasonde-gestützte Resektion der intrakraniellen Meningeome, eine Machbarkeitsstudie
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Autoren
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Darius Kalasauskas
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Pia Elisabeth Baqué
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Department of Nuclear Medicine, Mainz, Deutschland
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Helmut Reber
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Department of Nuclear Medicine, Mainz, Deutschland
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Jens Conrad
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Eike Schwandt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Naureen Keric
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Mathias Schreckenberger
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Department of Nuclear Medicine, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Meningioma resection in case of intraosseous and intramuscular expansion or the differentiation between relapsed tumor and scar tissue can be challenging, as the tumor margin may be difficult to identify. Somatostatin receptor (SSTR-2) is expressed by meningioma and can be used for visualization of the tumor extent in PET and SPECT imaging. Gamma probe, a hand-held device for detection of radionuclides is routinely used in other surgical specialties to identify target lesions. In this feasibility study, we examined the utility of intraoperative application of gamma probe to detect the remaining radioactivity after SSTR-2-specific tracer scintigraphy.
Methods: 99mTc-EDDA/HYNIC-TOC (Tectrotyd) was used to visualize intraosseous extent of meningioma in 4 cases, as part of routine preoperative SPECT imaging. The patients underwent tumor resection the next day. In 3 cases, a laparoscopic 45° gamma probe, and in 1 case, a short flexible 0° gamma probe (both Crystal Photonics, Germany) were used to measure the tracer radioactivity on the tumor surface, inside the tumor, on the dural tail as well in the intraosseous tumor extension.
Results: We performed a resection of frontobasal, petroclival, cerebellar and relapsed sphenoorbital meningioma using gamma probe in addition to navigation system as a resection guide. Gamma probe could readily identify the tumor margin and infiltration of bone in all 4 cases. The surgeon has found the 45° gamma probe a useful tool for the determination of tumor margin in frontobasal, sphenoorbital and cerebellar tumors. The probe was however too large for the use in case of deep-seated petroclival meningioma. A false-positive signal was registered next to the pituitary gland due to the presence of somatostatin receptors.
Conclusion: The use of gamma probe may be a valuable tool to guide and verify the resection of intracranial meningioma. Caution should be taken adjacent to the pituitary gland due to naturally occurring somatostatin receptors.
