Intraoperative 5-aminolevulinic acid–induced fluorescence in primary central nervous system lymphoma

Grossman, Rachel; Nossek, Erez; Shimony, Nir; Raz, Michal; Ram, Zvi

doi:10.3171/2013.9.jns131076

Cited by 25 publications

(15 citation statements)

References 8 publications

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“…These studies have shaped current views on the role of respective surgery for PCNSL; however their interpretation must take into account the following:

Most of these reports are post-hoc retrospective analyses of data from studies that were not designed or powered to evaluate the benefit of surgery for PCNSL.

The therapeutic benefit of surgery was often evaluated in the absence of standardized chemotherapy, such as concomitant high-dose systemic methotrexate and steroids, making any extrapolation of the findings irrelevant to the current standard of care for these patients.

Resective surgery is likely considerably safer than in the past. Technological advancements such as of modern imaging, intraoperative monitoring and navigation techniques, as well as fluorescence-guided microsurgery [25] allow for resections of brain tumors with reasonable morbidity.

…”

Section: Introductionmentioning

confidence: 99%

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Primary Central Nervous System Lymphoma: A Critical Review of the Role of Surgery for Resection

2016

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Background Primary central nervous system lymphomas (PCNSL) are rare CNS tumors that carry a poor prognosis, with most patients suffering recurrence. Progress has been made in the treatment of this pathology, notably with the widespread use of systemic high dose methotrexate. However, unlike most other malignant CNS neoplasms, surgery for cytoreduction is not routinely performed for this disease, mainly as a result of negative experiences decades ago. Since these studies were published, the availability of intraoperative monitoring, MR imaging and neuro-navigation as well as surgical adjuncts such as fluorescence- guided resection have greatly improved the safety of intracranial procedures. More recent data is suggestive of a potential survival benefit for resection of single PCNSL lesions when patients are subsequently treated with modern regimen high-dose methotrexate, yet this evidence is limited, and should be interpreted conservatively. Methods and findings A systematic review of the literature was performed to identify trials evaluating surgical options for the treatment of PCNSL. Conclusion In this review, we provide a critical overview of the evidence favoring and discouraging resection for PCNSL. This literature suffers from several biases and limitations that must be considered in the context of the extrapolation of this literature into clinical decision-making.

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“…These studies have shaped current views on the role of respective surgery for PCNSL; however their interpretation must take into account the following:

Most of these reports are post-hoc retrospective analyses of data from studies that were not designed or powered to evaluate the benefit of surgery for PCNSL.

…”

Section: Introductionmentioning

confidence: 99%

“…Technological advancements such as of modern imaging, intraoperative monitoring and navigation techniques, as well as fluorescence-guided microsurgery [25] allow for resections of brain tumors with reasonable morbidity.…”

Section: Introductionmentioning

confidence: 99%

Primary Central Nervous System Lymphoma: A Critical Review of the Role of Surgery for Resection

2016

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“…PCNSLs within fourth ventricle are relatively seldom seen in immune-competent patients. To the best of our knowledge, only nine cases of PCNSL located at fourth ventricle have been reported in the literature (Table 1) [1][2][3][4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Primary Central Nervous System Lymphoma in the Fourth Ventricle

Xinyi¹,

Qiu²,

Rong³

et al. 2017

J Neuroinfect Dis

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Primary central nervous system lymphoma (PCNSL), a highly malignant and infrequent tumor, is rarely found within the fourth ventricle. Here we report a case of isolated lymphoma within the fourth ventricle: a 61-year-old male presented with headache, mental disorder, abnormal gait and urinary incontinence. Based on the clinical symptoms and neuroimage, He was initially diagnosed as choroid plexus papilloma. However, post-surgery pathology corrected the diagnosis as a diffuse large B-cell lymphoma. To the best of our knowledge, only nine cases are documented in the literature and all of them were initially diagnosed as other tumours or not determined. Therefore, Thesis unconventional location and atypical clinical manifestation of PCNSL in the fourth ventricle should be included on the list of differential diagnosis of the fourth ventricle tumors. Case ReportA 61-year-old man presented to our hospital complaining of headache for one month and somnolence, abnormal gait and urinary incontinence for one week. During admission, he was in a state of somnolence and physical examination only revealed the mild cervical resistance. His past medical history and laboratory tests including routine blood parameters, blood biochemistry (including lactate dehydrogenase (LDH) HIV testing), routine coagulation parameters and erythrocyte sedimentation rate were normal as well.Brain magnetic resonance imaging (MRI) revealed one irregular nodule occupying the fourth ventricle with a hypo intensity on T1 weighted image (T1WI) and is intensity on T2 weighted image (T2WI) (Figure 1). Post-contrast T1WI showed well-defined and marked homogenous enhancement without necrosis. Furthermore, contrast enhancement image demonstrated that the primary nidus of the mass originated from the roof of the forth ventricle, which was surrounded with choroid plexus (Figure 2). The intraventricular location of the mass and MRI manifestation led us to clinical diagnosis as choroid plexus papilloma (CPP). PET-CT of the whole body showed high metabolism in the fourth ventricle. The special location of the mass prompted our surgical team to choose surgical excision over stereotactic biopsy.Interestingly, post-surgery pathology diagnosed as a diffuse large Bcell lymphoma (Figure 3). The patient refused to undergo radiotherapy or chemotherapy immediately after the surgery. At 6-week follow-up after the resection, brain MRI demonstrated enhanced nodules in the third ventricle and midbrain aqueduct area, which were considered as implantation metastases. Consequently, the patient was administrated with chemotherapy combined with radiotherapy. Another month later, these lesions amazingly disappeared on brain MRI. Currently, 20 months post-surgery, the patient is still under active follow-up.

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“…Passive accumulation of porphyrins in tumors results in enhanced fluorescent signal in the tumor. Successful applications of 5-ALA were reported in resection guidance of intracranial tumors[69–73], spinal meningioma[74], hepatocellular carcinoma[75] and bladder tumors[76], as well as gastric cancer staging with fluorescence laparoscopy[77]. Nanoparticles are also a class of materials that can take advantage of passive targeting.…”

Section: Target-specific Fluorescent Probes: the Driving Force Formentioning

confidence: 99%

Fluorescent imaging of cancerous tissues for targeted surgery

Bu¹,

Shen

Cheng

2014

Advanced Drug Delivery Reviews

108

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To maximize tumor excision and minimize collateral damage is the primary goal of cancer surgery. Emerging molecular imaging techniques have to “image-guided surgery” developing into “molecular imaging-guided surgery”, which is termed “targeted surgery” in this review. Consequently, the precision of surgery can be advanced from tissue-scale to molecule-scale, enabling “targeted surgery” to be a component of “targeted therapy”. Evidence from numerous experimental and clinical studies has demonstrated significant benefits of fluorescent imaging in targeted surgery with preoperative molecular diagnostic screening. Fluorescent imaging can help to improve intraoperative staging and enable more radical cytoreduction, detect obscure tumor lesions in special organs, highlight tumor margins, better map lymph node metastases, and identify important normal structures intraoperatively. Though limited tissue penetration of fluorescent imaging and tumor heterogeneity are two major hurdles for current targeted surgery, multimodality imaging and multiplex imaging may provide potential solutions to overcome these issues, respectively. Moreover, though many fluorescent imaging techniques and probes have been investigated, targeted surgery remains at a proof-of-principle stage. The impact of fluorescent imaging on cancer surgery will likely be realized through persistent interdisciplinary amalgamation of research in diverse fields.

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Intraoperative 5-aminolevulinic acid–induced fluorescence in primary central nervous system lymphoma

Cited by 25 publications

References 8 publications

Primary Central Nervous System Lymphoma: A Critical Review of the Role of Surgery for Resection

Primary Central Nervous System Lymphoma: A Critical Review of the Role of Surgery for Resection

Primary Central Nervous System Lymphoma in the Fourth Ventricle

Fluorescent imaging of cancerous tissues for targeted surgery

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