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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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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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  • presenting/speaker Petra Andreea Mercea - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Matthias Millesi - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Barbara Kiesel - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Mario Mischkulnig - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Vanessa Mazanec - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Thomas Roetzer - Medizinische Universität Innsbruck, Klinisches Institut für Neurologie und Neuropathologie, Wien, Austria
  • Adelheid Woehrer - Medizinische Universität Innsbruck, Klinisches Institut für Neurologie und Neuropathologie, Wien, Austria
  • Stefan Wolfsberger - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Johannes Herta - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Karl Roessler - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Engelbert Knosp - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
  • Georg Widhalm - Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP176

doi: 10.3205/20dgnc460, urn:nbn:de:0183-20dgnc4604

Published: June 26, 2020

© 2020 Mercea et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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.