Fluorescence Behavior and Dural Infiltration of Meningioma Analyzed by 5-Aminolevulinic Acid–Based Fluorescence: Operating Microscope Versus Mini-Spectrometer

Knipps, Johannes; Beseoglu, Kerim; Kamp, Marcel A.; Fischer, Igor; Felsberg, Joerg; Neumann, Lisa Margarete; Steiger, Hans‐Jakob; Cornelius, Jan Frédérick

doi:10.1016/j.wneu.2017.08.140

Cited by 22 publications

(15 citation statements)

References 22 publications

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“…Nevertheless, the histopathological correlate of visible 5-ALA fluorescence in intracranial meningiomas is still unclear. In this sense, previous studies (see Table 3) are limited by the small number of patients, inclusion of meningiomas with specific WHO grades only, primary focus on certain localizations such as infiltrated bone and on quantitative measurements of 5-ALA induced protoporphyrin IX (PpIX) accumulation [20,24,25]. However, the histopathological analysis of tumor bulk as well as peritumoral tissue in a large series would be of major importance to improve the precision of meningioma surgery and therefore reduce the risk of local tumor recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Knipps et al [25] analyzed 42 fluorescing biopsies of the tumor bulk in a series consisting of WHO grade I and II meningiomas. Similar to our observations, the authors found meningioma tissue in the vast majority of fluorescing biopsies derived from the tumor bulk (41 of 42 samples; 98%) [25]. In sum, our current data in the largest cohort of separate tissue samples with visible 5-ALA fluorescence from the tumor bulk including all WHO grades demonstrate a very high PPV for detecting meningioma tissue and confirm the preliminary observations of the first smaller studies [20,25].…”

Section: Present Studymentioning

confidence: 99%

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High Diagnostic Accuracy of Visible 5‐ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue

Wadiura¹,

Millesi²,

Makolli

et al. 2020

Lasers Surg Med

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Background and Objectives: Complete neurosurgical resection of intracranial meningiomas is essential to avoid residual tumor tissue and thus minimize the risk of tumor recurrence. However, local recurrence of meningiomas is not uncommon mainly due to insufficient intraoperative detection of residual tumor tissue within the tumor bulk or peritumoral tissue such as bone and satellite lesions. Although 5-aminolevulinic acid (5-ALA) induced fluorescence was found to visualize the majority of meningiomas, no comprehensive histopathological assessment of fluorescing samples from the tumor bulk and peritumoral tissue is available. The aim of our study was thus to histopathologically analyze a large series of tissue samples derived from meningioma surgery to assess the positive predictive value (PPV) of visible 5-ALA fluorescence. Study Design/Materials and Methods: In this study, we retrospectively investigated a series of tissue samples with visible 5-ALA fluorescence collected during surgery of intracranial meningiomas from the tumor bulk and peritumoral tissue including the bone flap, dura/dural tail, arachnoidea, adjacent cortex, and satellite lesions. The tumor diagnosis was established according to the World Health Organization (WHO) criteria and all collected fluorescing samples were screened for presence of tumor tissue to calculate the PPV. Results: Altogether, 191 tissue samples with visible 5-ALA fluorescence derived during surgery of 85 meningiomas (63 WHO grade I, 17 WHO grade II, and 5 WHO grade III) were included. In detail, 158 samples from the tumor bulk and 33 specimens from the peritumoral tissue were investigated. According to histopathological analysis, the PPV of 5-ALA fluorescence was significantly higher in samples from the tumor bulk (100%) as compared with peritumoral tissue (73%; P < 0.001). With regard to peritumoral tissue, tumor tissue was present in most fluorescing samples from the satellite lesions (100%), the bone flap (92%), arachnoidea (83%), and dura/dural tail (75%). In contrast, tumor tissue was absent in the majority of samples from fluorescing cortex (six of seven samples; 86%). However, distinct reactive tissue alterations were found in all six tumor-free fluorescing cortex samples and additional vascular proliferation in two cases. Conclusion: In this largest series to date, visible 5-ALA fluorescence is characterized by a high PPV detecting tumor bulk and peritumoral tissue in intracranial meningiomas. Thus, 5-ALA fluorescence supports the neurosurgeon in identifying residual tumor tissue at relevant surgical sites to optimize meningioma surgery and minimize the risk of local recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Present Studymentioning

confidence: 99%

High Diagnostic Accuracy of Visible 5‐ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue

Wadiura¹,

Millesi²,

Makolli

et al. 2020

Lasers Surg Med

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“…In meningiomas, PpIX fluorescence is usually very heterogeneous and false negatives and false positives occur more frequently than with GBM. A meta‐analysis of studies with FGS of meningiomas by Foster and Eljamel finds that the surgical plan was “altered intraoperatively in 75% of high‐grade and 19% of low‐grade meningiomas, improving the extent of surgical excision.” In a recent report by Knipps et al PpIX spectroscopy proved much more sensitive and only slightly less specific than imaging in detecting the extension of 13 meningiomas.…”

Section: Fluorescence Guided Surgerymentioning

confidence: 96%

5‐ALA in the management of malignant glioma

Stepp¹,

2018

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Background: Patients suffering from malignant gliomas have a poor prognosis. For the surgical treatment of these tumors, 5-aminolevulinic acid (5-ALA) has become a new standard. Aims: This review intends to provide an overview over current status, significance, limitations, and future perspectives of 5-ALA based fluorescence guided surgery and photodynamic therapy for brain tumor patients. Materials and Methods: From peer reviewed publications on the many aspects connected with this topic, those with potential clinical relevance were selected and put in the context of our own experience. Results and Discussion: The high tumor selectivity of accumulation of fluorescent protoporphyrin IX (PpIX) after systemic administration of 5-ALA enables intra-operative fluorescence guidance, which is unimpaired by brainshift and does not require expensive equipment. The neurosurgical aim of complete resection of enhancing tumor can now more easily be achieved, which improves prognosis in these patients. Nevertheless, despite better surgery tumors will inevitably recur. In order to further prolong survival, the phototoxic properties of PpIX are presently being exploited in clinical trials of post-operative or interstitial photodynamic therapy (PDT). Conclusion: 5-ALA based fluorescence guidance and PDT offer an intriguing new option for the management of malignant gliomas. Lasers Surg. Med. 50:399-419, 2018.

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“…В работе J. Knipps и соавт. [42] были изучены 104 биоптата из 13 менингиом, флуоресценция которых оценивалась с помощью микроскопа, а также миниспектрометра ех vivo. Исследования показали, что чувствительность и специфичность метода с применением микроскопа составили 96 и 53%, а с применением миниспектрометра -95 и 93% соответственно.…”

Section: рис 6 пациентка б (клиническое наблюдение №4)unclassified

Intraoperative fluorescence diagnostics in surgery of intracranial meningiomas: analysis of 101 cases

et al. 2018

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Fluorescence Behavior and Dural Infiltration of Meningioma Analyzed by 5-Aminolevulinic Acid–Based Fluorescence: Operating Microscope Versus Mini-Spectrometer

Cited by 22 publications

References 22 publications

High Diagnostic Accuracy of Visible 5‐ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue

High Diagnostic Accuracy of Visible 5‐ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue

5‐ALA in the management of malignant glioma

Intraoperative fluorescence diagnostics in surgery of intracranial meningiomas: analysis of 101 cases

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