Jane Skjøth-Rasmussen1, Lars Bøgeskov2, Astrid Sehested3, Camilla Klausen4, Helle Broholm5, Karsten Nysom3. 1. Department of Neurosurgery, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark. jane@skjoeth-rasmussen.dk. 2. Department of Neurosurgery, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark. 3. Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark. 4. Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark. 5. Department of Pathology, Rigshospitalet, Copenhagen, Denmark.
Abstract
PURPOSE: Medulloblastoma is the most common malignant brain tumor in childhood. Radical surgery in the non-metastatic stage is an important factor with respect to overall survival. In this case, 5-aminolevulinic acid (5-ALA) was used at second-look surgery in order to improve surgical results. METHODS: The child was pretreated with 3 × 4 mg dexamethasone for 4 days prior to the second surgery. At 5 a.m. on the day of surgery, a freshly prepared solution of 5-ALA (20 mg/kg body weight; Medac, Germany) was given orally. RESULTS: At surgery, through the original opening, the vague red fluorescence of the tumor was clearly distinctive from the cerebellum with no tumor infiltration. All fluorescent tissue was removed. Postoperative MRI gave suspicion of yet at small tumor residue, but this structure is less than 1.5 ml in calculated volume, and consequently the recommended adjuvant therapy of the child changed from the high-risk medulloblastoma regimen to the standard-risk regimen. CONCLUSIONS: In this particular difficult case of non-contrast-enhancing tumor, 5-ALA was of vital importance to improve rate of resection and change the aggressiveness needed in postsurgery radiation therapy.
PURPOSE:Medulloblastoma is the most common malignant brain tumor in childhood. Radical surgery in the non-metastatic stage is an important factor with respect to overall survival. In this case, 5-aminolevulinic acid (5-ALA) was used at second-look surgery in order to improve surgical results. METHODS: The child was pretreated with 3 × 4 mg dexamethasone for 4 days prior to the second surgery. At 5 a.m. on the day of surgery, a freshly prepared solution of 5-ALA (20 mg/kg body weight; Medac, Germany) was given orally. RESULTS: At surgery, through the original opening, the vague red fluorescence of the tumor was clearly distinctive from the cerebellum with no tumor infiltration. All fluorescent tissue was removed. Postoperative MRI gave suspicion of yet at small tumor residue, but this structure is less than 1.5 ml in calculated volume, and consequently the recommended adjuvant therapy of the child changed from the high-risk medulloblastoma regimen to the standard-risk regimen. CONCLUSIONS: In this particular difficult case of non-contrast-enhancing tumor, 5-ALA was of vital importance to improve rate of resection and change the aggressiveness needed in postsurgery radiation therapy.
Entities:
Keywords:
5-ALA; Medulloblastoma; Pediatric; Radical surgery
Authors: S Eicker; S Sarikaya-Seiwert; A Borkhardt; K Gierga; B Turowski; H-J Heiroth; H-J Steiger; W Stummer Journal: Cent Eur Neurosurg Date: 2010-10-07
Authors: Walter Stummer; Floriano Rodrigues; Philippe Schucht; Matthias Preuss; Dorothee Wiewrodt; Ulf Nestler; Marco Stein; José Manuel Cabezudo Artero; Nunzio Platania; Jane Skjøth-Rasmussen; Alessandro Della Puppa; John Caird; Søren Cortnum; Sam Eljamel; Christian Ewald; Laura González-García; Andrew J Martin; Ante Melada; Aurelia Peraud; Angela Brentrup; Thomas Santarius; Hans Herbert Steiner Journal: Acta Neurochir (Wien) Date: 2014-09-24 Impact factor: 2.216