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Fluorescence-guided resection in bone and soft tissue infiltrating meningiomas

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

Bone infiltration of the tumour is common in meningioma surgery. This may also affect patients without indicative signs of bone infiltration on preoperative imaging. Unrecognized bone invasion may lead to higher recurrence rates. 5-ALA fluorescence–guided resection (5-ALA-fg) could be a promising tool to help recognize possible bone invasion and/or tumour remnants. However, there is still little data about 5-ALA-fg resection in bone and soft tissue infiltrating meningiomas.

Methods

We performed a retrospective study of 11 patients who were operated with the aid of 5-ALA due to bone and soft tissue infiltrating meningiomas at the University Hospital of St. Poelten between 2013 and 2019.

Results

Strong and homogeneous fluorescence of the meningioma was observed in 9 cases (81.8%) and vague and heterogeneous fluorescence in 2 cases (18.2%). Hyperostosis on computerized tomography was evident in 3 of 6 cases (50%) and bone infiltration was visible in preoperative magnetic resonance imaging in 7 of 11 patients (63.6%). All eleven patients showed positive fluorescence of the bone infiltrating part. In all 7 cases where tissue could be collected, histopathological testing verified tumour infiltration (100%). There was also fluorescence of the periosteum in 3 cases and histopathological testing verified tumour infiltration in 100%.

Conclusion

There is growing evidence that 5-ALA-fg resection can help to identify bone infiltration in meningioma surgery. Therefore, it may help to improve extent of resection. However, further studies are necessary to investigate the rate of false-negative fluorescence and its effect on progression free survival. If 5-ALA-fg resection of meningioma is performed, the attending surgeon should also consider investigating the adjacent periosteum under blue light for detection of possible fluorescence.

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References

  1. Abdelzaher E, El-Gendi SM, Yehya A, Gowil AG (2011) Recurrence of benign meningiomas: predictive value of proliferative index, BCL2, p53, hormonal receptors and HER2 expression. Br J Neurosurg 25(6):707–713

    Article  PubMed  Google Scholar 

  2. Coluccia D, Fandino J, Fujioka M, Cordovi S, Muroi C, Landolt H (2010) Intraoperative 5-aminolevulinic-acid-induced fluorescence in meningiomas. Acta Neurochir 152(10):1711–1719

    Article  PubMed  Google Scholar 

  3. Della Puppa A, Scienza R (2013) 5-Aminolevulinic acid-guided resection of bone-invasive meningiomas. Neurosurg Focus 35(4):E6

    Article  PubMed  Google Scholar 

  4. Della Puppa A, Rustemi O, Gioffrè G et al (2014) Predictive value of intraoperative 5-aminolevulinic acid-induced fluorescence for detecting bone invasion in meningioma surgery: clinical article. J Neurosurg 120(4):840–845

    Article  CAS  PubMed  Google Scholar 

  5. Gabeau-Lacet D, Aghi M, Betensky RA, Barker FG, Loeffler JS, Louis DN (2009) Bone involvement predicts poor outcome in atypical meningioma: clinical article. J Neurosurg 111(3):464–471

    Article  PubMed  PubMed Central  Google Scholar 

  6. Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH (2000) Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46(1):57–61

    Article  CAS  PubMed  Google Scholar 

  7. Goyal N, Kakkar A, Sarkar C, Agrawal D (2012) Does bony hyperostosis in intracranial meningioma signify tumor invasion a radio-pathologic study. Neurol India 60(1):50–54

    Article  PubMed  Google Scholar 

  8. Kajimoto Y, Kuroiwa T, Miyatake SI, Ichioka T, Miyashita M, Tanaka H, Tsuji M (2007) Use of 5-aminolevulinic acid in fluorescence-guided resection of meningioma with high risk of recurrence. Case report. J Neurosurg 106(6):1070–1074

    Article  PubMed  Google Scholar 

  9. Kallio M, Sankila R, Hakulinen T, Jääskeläinen J (1992) Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery 31(1):2–12

    CAS  PubMed  Google Scholar 

  10. Kunishio K, Ohmoto T, Furuta T, Matsumoto K, Nishimoto A (1994) Factors influencing the recurrence rate of intracranial meningiomas after surgery. Neurol Med Chir (Tokyo) 34(2):81–85

    Article  CAS  Google Scholar 

  11. Lam Shin Cheung V, Kim A, Sahgal A, Das S (2018) Meningioma recurrence rates following treatment: a systematic analysis. J Neuro-Oncol 136(2):351–361

    Article  Google Scholar 

  12. Lemée JM, Corniola MV, Da Broi M, Joswig H, Scheie D, Schaller K, Helseth E, Meling TR (2019) Extent of resection in meningioma: predictive factors and clinical implications. Sci Rep 9(1):1–6

    Article  CAS  Google Scholar 

  13. Millesi M, Kiesel B, Mischkulnig M, Martínez-Moreno M, Wöhrer A, Wolfsberger S, Knosp E, Widhalm G (2016) Analysis of the surgical benefits of 5-ALA-induced fluorescence in intracranial meningiomas: experience in 204 meningiomas. J Neurosurg 125(6):1408–1419

    Article  CAS  PubMed  Google Scholar 

  14. Morofuji Y, Matsuo T, Hayashi Y, Suyama K, Nagata I (2008) Usefulness of intraoperative photodynamic diagnosis using 5-aminolevulinic acid for meningiomas with cranial invasion: technical case report. Neurosurgery 62(3 SUPPL. 1):102–103 discussion 103-4

    PubMed  Google Scholar 

  15. Oya S, Kawai K, Nakatomi H, Saito N (2012) Significance of Simpson grading system in modern meningioma surgery: integration of the grade with MIB-1 labeling index as a key to predict the recurrence of WHO grade I meningiomas - clinical article. J Neurosurg 117(1):121–128

    Article  PubMed  Google Scholar 

  16. Pettersson-Segerlind J, Orrego A, Lönn S, Mathiesen T (2011) Long-term 25-year follow-up of surgically treated parasagittal meningiomas. World Neurosurg 76(6):564–571

    Article  PubMed  Google Scholar 

  17. Pieper DR, Al-Mefty O, Hanada Y, Buechner D (1999) Hyperostosis associated with meningioma of the cranial base: secondary changes or tumor invasion. Neurosurgery 44(4):742–747

    Article  CAS  PubMed  Google Scholar 

  18. Potapov AA, Goryaynov SA, Okhlopkov VA et al (2016) Laser biospectroscopy and 5-ALA fluorescence navigation as a helpful tool in the meningioma resection. Neurosurg Rev 39(3):437–447

    Article  CAS  PubMed  Google Scholar 

  19. Scheichel F, Ungersboeck K, Kitzwoegerer M, Marhold F (2017) Fluorescence-guided resection of extracranial soft tissue tumour infiltration in atypical meningioma. Acta Neurochir 159(6):1027–1031

    Article  PubMed  Google Scholar 

  20. Valdes PA, Bekelis K, Harris BT, Wilson BC, Leblond F, Kim A, Simmons NE, Erkmen K, Paulsen KD, Roberts DW (2014) 5-Aminolevulinic acid-induced protoporphyrin IX fluorescence in meningioma: qualitative and quantitative measurements in vivo. Neurosurgery 10(1):74–82

    PubMed  PubMed Central  Google Scholar 

  21. Valdes PA, Millesi M, Widhalm G, Roberts DW (2019) 5-aminolevulinic acid induced protoporphyrin IX (ALA-PpIX) fluorescence guidance in meningioma surgery. J Neuro-Oncol 141(3):555–565

    Article  CAS  Google Scholar 

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Acknowledgements

The authors thank Christoph Waldhart for technical assistance and the creating of the photographs.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100, St. Poelten, Austria

    Florian Scheichel, Branko Popadic, Karl Ungersboeck & Franz Marhold

  2. Department of Pathology, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100, St. Poelten, Austria

    Melitta Kitzwoegerer

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  1. Florian Scheichel
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  2. Branko Popadic
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  3. Melitta Kitzwoegerer
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  4. Karl Ungersboeck
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  5. Franz Marhold
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Corresponding author

Correspondence to Franz Marhold.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual patients included in the study.

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This article is part of the Topical Collection on Brain Tumors

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Scheichel, F., Popadic, B., Kitzwoegerer, M. et al. Fluorescence-guided resection in bone and soft tissue infiltrating meningiomas. Acta Neurochir 162, 605–611 (2020). https://doi.org/10.1007/s00701-019-04179-7

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  • DOI: https://doi.org/10.1007/s00701-019-04179-7

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