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Fluorescent diagnostics in brain and spinal cord tumors neurosurgery
Author(s): ,
A. Potapov
Affiliations:
N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
,
S. Goryaynov
Affiliations:
N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
,
D. Chelushkin
Affiliations:
N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
,
T. Savelieva
Affiliations:
A.M. Prokhorov General Physics Institute of Russian Academy of Sciences, GPI RAS, Moscow, Russia, Moscow, Russian Federation
,
V. Loschenov
Affiliations:
A.M. Prokhorov General Physics Institute of Russian Academy of Sciences, GPI RAS, Moscow, Russia, Moscow, Russian Federation
,
K. Chernishov
Affiliations:
I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
,
V. Okhlopkov
Affiliations:
N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
,
N. Konovalov
Affiliations:
N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
P. Zelenkov
Affiliations:
N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
EANS Academy. Potapov A. Oct 21, 2018; 226083; EP3110
Prof. Dr. Alexander Potapov
Prof. Dr. Alexander Potapov
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Abstract
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Abstract
Recently, 5-aminolevulinic acid (5-ALA) has been utilized as an adjuvant to the surgical resection of primary brain and spinal cord tumors and metastases. We perform our series of 591 cases, in which the neurosurgical operation was carried out with 5-ALA fluorescence navigation.
Introduction
5-ALA is widely used in various sections of neurooncology. Protoporphyrin IX, the main metabolite of 5-ALA, possesses strong fluorescence, is able to accumulate in tumors and serves as a highly sensitive and specific tool for visualizing a tumor during surgery.
Materials and Methods
A group of 591 patients was enrolled in this study; of them brain glial tumors were diagnosed in 342 cases, brain meningiomas - in 101 cases, brain metastases - in 60 cases. From 88 spinal cases 44 were ependimomas, 12 - astrocytoma cases, 4 - glioblastoma cases, 11 - meningiomas and others. In all cases surgery was performed with operative «Carl Zeiss Pentero» microscope equipped with a fluorescence module. Fluorescence intensity was evaluated in all cases.
Results
Visible fluorescence was marked in 83,1% of patients with glial tumors (in 43,1% of cases of low grade gliomas and in 89,1% of cases of high-grade gliomas), in 93,18% of patients with meningiomas and in 87,5% of patients with metastatic brain tumors.
Visual fluorescence was observed in 33 (75%) of 44 cases of intramedullary ependymomas, in 4 (33.3%) of 12 cases of spinal astrocitomas and in 11 (100%) of 11 cases of spinal meningiomas.
Conclusion
5-ALA- induced fluorescence diagnostics is a sensitive and highly effective method of intraoperative neuronavigation for patients with high grade brain gliomas, meningiomas, metastases and tumors of the spinal cord. Anatomical localization does not take influence on the visible fluorescence of tumors in our series.
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