Jungsu Choo1, Kazuhito Takeuchi2, Yuichi Nagata2, Fumiharu Ohka2, Yugo Kishida3, Tadashi Watanabe3, Yusuke Satoh4, Tetsuya Nagatani3, Kyozo Kato5, Toshihiko Wakabayashi2, Atsushi Natsume2. 1. Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: jonsu_the_sankakukin@yahoo.co.jp. 2. Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Department of Neurosurgery, Nagoya Daini Red Cross Hospital, Nagoya-shi, Japan. 4. Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan. 5. Department of Neurosurgery, Kariya Toyata General Hospital, Kariya-shi, Japan.
Abstract
BACKGROUND: Microscopic detection of intracranial brain tumors with 5-aminolevulinic acid (5-ALA) has proven extremely useful, and reports the use of 5-ALA have recently increased. However, few reports have described 5-ALA photodynamic diagnosis (PDD) using a neuroendoscope. We performed neuroendoscopic 5-ALA PDD for various brain lesions and present a procedure using only a neuroendoscope. METHODS: We describe the diagnosis of 20 intracranial brain lesion cases with a 5-ALA-guided fluorescence endoscope. A light-emitting diode that emitted either white light or 400- to 410-nm violet light was attached to a neuroendoscope. We performed cylinder surgery with a transparent sheath under observation with a rigid neuroendoscope. RESULTS: Neuroendoscopic biopsies were performed in 11 patients, and resections were performed in 9 patients. All lesions were observed with a neuroendoscope under sequential white light and violet light. We confirmed the presence of a red fluorescent lesion under violet light in 15 patients, including 4 of 5 glioblastoma cases (80%); 1 of 2 anaplastic astrocytoma cases (50%); 4 of 5 diffuse large B cell lymphoma cases (80%); 2 of 2 metastatic brain tumors; 1 of 1 case each of diffuse astrocytoma, pilocytic astrocytoma, inflammatory change, and germinoma (100%); and no cases of anaplastic ependymoma or cysticercosis. Pretargeted lesions were accurately harvested from all biopsy specimens. Gross total resection was achieved in 5 of 9 patients using a resection procedure. CONCLUSIONS: Our described method offers a promising technique for achieving precise brain tumor biopsies and safe resection.
BACKGROUND: Microscopic detection of intracranial brain tumors with 5-aminolevulinic acid (5-ALA) has proven extremely useful, and reports the use of 5-ALA have recently increased. However, few reports have described 5-ALA photodynamic diagnosis (PDD) using a neuroendoscope. We performed neuroendoscopic 5-ALAPDD for various brain lesions and present a procedure using only a neuroendoscope. METHODS: We describe the diagnosis of 20 intracranial brain lesion cases with a 5-ALA-guided fluorescence endoscope. A light-emitting diode that emitted either white light or 400- to 410-nm violet light was attached to a neuroendoscope. We performed cylinder surgery with a transparent sheath under observation with a rigid neuroendoscope. RESULTS: Neuroendoscopic biopsies were performed in 11 patients, and resections were performed in 9 patients. All lesions were observed with a neuroendoscope under sequential white light and violet light. We confirmed the presence of a red fluorescent lesion under violet light in 15 patients, including 4 of 5 glioblastoma cases (80%); 1 of 2 anaplastic astrocytoma cases (50%); 4 of 5 diffuse large B cell lymphoma cases (80%); 2 of 2 metastatic brain tumors; 1 of 1 case each of diffuse astrocytoma, pilocytic astrocytoma, inflammatory change, and germinoma (100%); and no cases of anaplastic ependymoma or cysticercosis. Pretargeted lesions were accurately harvested from all biopsy specimens. Gross total resection was achieved in 5 of 9 patients using a resection procedure. CONCLUSIONS: Our described method offers a promising technique for achieving precise brain tumor biopsies and safe resection.
Authors: Sergey A Goryaynov; Georg Widhalm; Maria F Goldberg; Danil Chelushkin; Aldo Spallone; Kosta A Chernyshov; Marina Ryzhova; Galina Pavlova; Alexander Revischin; Ludmila Shishkina; Vadim Jukov; Tatyana Savelieva; Loschenov Victor; Alexander Potapov Journal: Front Oncol Date: 2019-05-22 Impact factor: 6.244