Fluorescence-guided resection of extracranial soft tissue tumour infiltration in atypical meningioma

• Published in: Acta neurochirurgica Vol. 159; no. 6; pp. 1027 - 1031
• Main Authors: Scheichel, Florian, Ungersboeck, Karl, Kitzwoegerer, Melitta, Marhold, Franz
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.06.2017; Springer Nature B.V
• Subjects: Acids; Aged; Aminolevulinic acid; Aphasia; Brain cancer; Calvaria; Case Report - Brain Tumors; Female; Fluorescence; Heterogeneity; Humans; Interventional Radiology; Medicine; Medicine & Public Health; Meningeal Neoplasms - pathology; Meningeal Neoplasms - surgery; Meningioma; Meningioma - pathology; Meningioma - surgery; Metastases; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Postoperative Complications; Soft Tissue Neoplasms - secondary; Soft Tissue Neoplasms - surgery; Surgery; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - methods; Surgical Orthopedics; Tumors; Atypical meningioma; Bone invasion; 5-ALA; Fluorescence-guided resection
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-017-3166-4

The exact role of 5-aminolevulinic acid (5-ALA) fluorescence-guided meningioma resection is as yet unclear. Although most of the meningiomas show positive fluorescence, the influence on outcome, fluorescence heterogeneity within the tumour, the correlation between fluorescence and the proliferation rate, as well as different quantitative measurements are a matter of debate. Positive fluorescence in bone infiltrative meningiomas is well described, whereas little data exist about 5-ALA fluorescence within soft tissue infiltration. We add a case of histologically confirmed fluorescent tumour infiltration into soft tissue. A 78-year-old woman underwent resection of an atypical meningioma at the University Hospital of St. Poelten. Preoperative imaging showed tumour infiltration throughout the calvaria. 5-ALA fluorescence of the tumour as well as bone, periost and temporal muscle helped to perform a gross total resection. Histological examination showed an atypical meningioma (WHO Grade II) and gave proof of tumour infiltration of the bone and temporal muscle. With the aid of 5-ALA fluorescence, a gross total resection could be performed.