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Intraoperative 5-aminolevulinic-acid-induced fluorescence in meningiomas

  • Clinical Article
  • Published:
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Abstract

Object

5-aminolevulinic acid (5-ALA) has gained importance as an intraoperative photodynamic diagnostic agent for the extirpation of malignant gliomas. The application of this technique for resection of meningiomas has barely been explored. The aim of this study was to evaluate the utility of 5-ALA-induced fluorescence as a visual tool in meningioma resection and its correlation with histological findings.

Methods

A total of 33 consecutive patients undergoing resection of intracranial meningiomas from December 2007 to August 2009 were included in this study. After confirmation of normal liver function, 5-ALA was administered orally (20 mg/kg) within 3–5 h prior to skin incision. All cases were operated on using standard microsurgical and neuronavigation-guided techniques. Intraoperative 440 nm fluorescence was applied periodically during and at the end of resection in order to detect tumor-infiltrated sites. The fluorescence of the tumor was evaluated intraoperatively by the surgeon and confirmed by subsequent video analysis.

Results

A total of 32 (97%) patients presented with benign meningiomas (WHO I–II). In 1 (3%) patient, histological anaplastic signs (WHO III) could be demonstrated. 5-ALA-induced fluorescence of the tumor was confirmed in a total of 31 (94%) patients. The fluorescence did not correlate with the histological findings (n = 30 WHO I–II, n = 1 WHO grade III) or with preoperative brain edema and administration of steroids. A total resection could be postoperatively demonstrated in 25 (76%) patients. No adverse effects attributable to 5-ALA occurred.

Conclusions

5-ALA-induced fluorescence is a useful and promising intraoperative tool for the visualization of meningioma tissue. The novel findings demonstrated in this study in terms of high fluorescence and poor correlation with histological findings highlight the usefulness of this technique as a routine visual tool to achieve optimal resection of meningiomas.

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Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland

    Daniel Coluccia, Javier Fandino, Masayuki Fujioka, Carl Muroi & Hans Landolt

  2. Department of Pathology, Kantonsspital Aarau, Aarau, Switzerland

    Susanne Cordovi

Authors
  1. Daniel Coluccia
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  2. Javier Fandino
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  3. Masayuki Fujioka
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  4. Susanne Cordovi
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  5. Carl Muroi
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  6. Hans Landolt
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Corresponding author

Correspondence to Javier Fandino.

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Comment

The authors gave 5-ALA (Gliolan) 3–5 h preoperatively to 33 patients with intracranial meningiomas and observed fluorescence in 31/33—with no correlation to various clinical characteristics. This is an important pilot study that should be verified by other neurosurgical teams. Why meningioma tissue becomes fluorescent after 5-ALA requires research at tissue/cellular/molecular level. Further studies—if 5-ALA becomes cheaper—will determine whether and when this approach improves the degree of removal of meningiomas. Furthermore, 5-ALA should be tested in many other benign tumors of the CNS, including schwannomas, adenomas, and some 20 different types of grade I gliomas such as pilocytic astrocytomas.

Most importantly, 5-ALA painting is just a beginning to the new era of advanced optics in neurosurgery—clinical testing and verification of various targeted painting molecules in different instances.

Juha E Jääskeläinen

Neurosurgery/NeuroCenter/Kuopio University Hospital

Kuopio Finland

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Coluccia, D., Fandino, J., Fujioka, M. et al. Intraoperative 5-aminolevulinic-acid-induced fluorescence in meningiomas. Acta Neurochir 152, 1711–1719 (2010). https://doi.org/10.1007/s00701-010-0708-4

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  • DOI: https://doi.org/10.1007/s00701-010-0708-4

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