scholarly journals Quantitative and qualitative 5-aminolevulinic acid–induced protoporphyrin IX fluorescence in skull base meningiomas

2011 ◽  
Vol 30 (5) ◽  
pp. E8 ◽  
Author(s):  
Kimon Bekelis ◽  
Pablo A. Valdés ◽  
Kadir Erkmen ◽  
Frederic Leblond ◽  
Anthony Kim ◽  
...  
Keyword(s):  
Skull Base ◽  
Aminolevulinic Acid ◽  
Tumor Resection ◽  
Protoporphyrin Ix ◽  
Complete Resection ◽  
Qualitative Assessment ◽  
Neoplastic Tissue ◽  
Surgical Microscope ◽  
Skull Base Meningioma ◽  
Skull Base Meningiomas

Object Complete resection of skull base meningiomas provides patients with the best chance for a cure; however, surgery is frequently difficult given the proximity of lesions to vital structures, such as cranial nerves, major vessels, and venous sinuses. Accurate discrimination between tumor and normal tissue is crucial for optimal tumor resection. Qualitative assessment of protoporphyrin IX (PpIX) fluorescence following the exogenous administration of 5-aminolevulinic acid (ALA) has demonstrated utility in malignant glioma resection but limited use in meningiomas. Here the authors demonstrate the use of ALA-induced PpIX fluorescence guidance in resecting a skull base meningioma and elaborate on the advantages and disadvantages provided by both quantitative and qualitative fluorescence methodologies in skull base meningioma resection. Methods A 52-year-old patient with a sphenoid wing WHO Grade I meningioma underwent tumor resection as part of an institutional review board–approved prospective study of fluorescence-guided resection. A surgical microscope modified for fluorescence imaging was used for the qualitative assessment of visible fluorescence, and an intraoperative probe for in situ fluorescence detection was utilized for quantitative measurements of PpIX. The authors assessed the detection capabilities of both the qualitative and quantitative fluorescence approaches. Results The patient harboring a sphenoid wing meningioma with intraorbital extension underwent radical resection of the tumor with both visibly and nonvisibly fluorescent regions. The patient underwent a complete resection without any complications. Some areas of the tumor demonstrated visible fluorescence. The quantitative probe detected neoplastic tissue better than the qualitative modified surgical microscope. The intraoperative probe was particularly useful in areas that did not reveal visible fluorescence, and tissue from these areas was confirmed as tumor following histopathological analysis. Conclusions Fluorescence-guided resection may be a useful adjunct in the resection of skull base meningiomas. The use of a quantitative intraoperative probe to detect PpIX concentration allows more accurate determination of neoplastic tissue in meningiomas than visible fluorescence and is readily applicable in areas, such as the skull base, where complete resection is critical but difficult because of the vital structures surrounding the pathology.

The role of radical microsurgical resection in multimodal treatment for skull base meningioma

2010 ◽  
Vol 113 (5) ◽  
pp. 1072-1078 ◽  
Author(s):  
Tsutomu Ichinose ◽  
Takeo Goto ◽  
Kenichi Ishibashi ◽  
Toshihiro Takami ◽  
Kenji Ohata
Keyword(s):  
Skull Base ◽  
Recurrence Rate ◽  
Combined Treatment ◽  
Tumor Resection ◽  
Tumor Location ◽  
Karnofsky Performance Scale ◽  
Skull Base Meningioma ◽  
The Mean ◽  
Skull Base Meningiomas ◽  
Recurrence Group

Object Because resection followed by timely stereotactic radiosurgery (SRS) is becoming a standard strategy for skull base meningiomas, the role of initial surgical tumor reduction in this combined treatment should be clarified. Methods This study examined 161 patients with benign skull base meningiomas surgically treated at Osaka City University between January 1985 and December 2005. The mean follow-up period was 95.3 months. Patients were categorized into 3 groups based on the operative period and into 4 groups based on tumor location. Maximal resection was performed as first therapy throughout all periods. In the early period (1985–1994), in the absence of SRS, total excision of the tumor was intentionally performed for surgical cure of the disease. In the mid and late periods (1995–2000 and 2001–2005), small parts of the tumor invading critical neurovascular structures were left untouched to obtain good functional results. Residual tumors with high proliferation potential (Ki 67 index > 4%) or with progressive tendencies were treated with SRS. The extent of initial tumor resection, recurrence rate, Karnofsky Performance Scale score, and complication rate were investigated in each group. Results The mean tumor equivalent diameter of residual tumors was 3.67 mm in the no-recurrence group and 11.7 mm in the recurrence group. The mean tumor resection rate (TRR) was 98.5% in the no-recurrence group and 90.1% in the recurrence group. A significant relationship was seen between postoperative tumor size, TRR, and recurrence rate (p < 0.001), but the recurrence rate showed no significant relationship with any other factors such as operative period (p = 0.48), tumor location (p = 0.76), or preoperative tumor size (p = 0.067). The mean TRR was maintained throughout all operative periods, but the complication rate was lowest and postoperative Karnofsky Performance Scale score was best in the late period (p < 0.001 each). Late-period results were as follows: mean TRR, 97.9%; mortality rate, 0%; and severe morbidity rate, 0%. Stereotactic radiosurgery procedures were added in 27 cases (16.8%) across all periods. Throughout all follow-up periods, 158 tumors were satisfactorily controlled by maximal possible excision alone or in combination with adequate SRS. Conclusions The combination of maximal possible resection and additional SRS improves functional outcomes in patients with skull base meningioma. A TRR greater than 97% in volume can be achieved with satisfactory functional preservation and will lead to excellent tumor control in combined treatment of skull base meningioma.

Protoporphyrin-IX Fluorescence in Skull Base Meningiomas' Resection

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Tang ManHon ◽  
Carol Goodman ◽  
Harry Moseley ◽  
Sam Eljamel
Keyword(s):  
Skull Base ◽  
Protoporphyrin Ix ◽  
Skull Base Meningiomas

scholarly journals Short diameter may be a useful simple indicator of the tumor response in skull base meningiomas after conventionally fractionated stereotactic radiotherapy

2021 ◽  
Author(s):  
Keiichi Takehana ◽  
Daisuke Nakamura ◽  
Alshaymaa Abdelghaffar ◽  
Megumi Uto ◽  
Tomohiro Katagiri ◽  
...  
Keyword(s):  
Skull Base ◽  
Stereotactic Radiotherapy ◽  
Tumor Volume ◽  
Tumor Response ◽  
Fractionated Stereotactic Radiotherapy ◽  
Skull Base Meningioma ◽  
Skull Base Meningiomas ◽  
Simple Indicator ◽  
Conventionally Fractionated

Abstract Objectives The purpose of this study was to assess the radiological change patterns in skull base meningiomas after conventionally fractionated stereotactic radiotherapy (CFSRT) to determine a simple and valid method to assess the tumor response. Materials and methods Forty-one patients with a benign skull base meningioma treated by CFSRT from March 2007 to August 2015 were retrospectively evaluated. We measured tumor volume (TV), long-axis diameter (LD), and short-axis diameter (SD) on both pre-treatment images and follow-up images of 1, 3, and 5 years after CFSRT, respectively. The paired t test was used to detect differences in the LD and SD change rates. Spearman’s correlation coefficients were calculated to evaluate relationships between the TV and the diameters changes. Results The number of available follow-up MRIs that was performed at 1, 3, and 5 years after the CFSRT was 41 (100%), 34 (83%), and 23 (56%), respectively. The change rates of SD were significantly higher than those of LD at every time point and more strongly correlated with the change rates of tumor volume at 3 and 5 years after CFSRT. Conclusions SD may be useful as a simple indicator of the tumor response for skull base meningioma after CFSRT. Key Points • The change rate in short-axis diameter is a useful and simple indicator of the response of skull base meningioma to conventionally fractionated stereotactic radiotherapy. • Conventionally fractionated stereotactic radiotherapy for skull base meningioma achieved excellent 5-year local control.

Endoscopic Fluorescence-Guided Resection Increases Radicality in Glioblastoma Surgery

2019 ◽  
Vol 18 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Christoph Bettag ◽  
Abdelhalim Hussein ◽  
Daniel Behme ◽  
Theoni Maragkou ◽  
Veit Rohde ◽  
...  
Keyword(s):  
Tumor Tissue ◽  
Aminolevulinic Acid ◽  
Histopathological Examination ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Complete Resection ◽  
Free Survival ◽  
Resected Tissue ◽  
Microsurgical Resection

Abstract BACKGROUND Several studies have proven the benefit of a greater extent of resection on progression-free survival and overall survival in glioblastoma (GBM). Possible reasons for incomplete tumor resection might be wrong interpretation of fading fluorescence or overseen fluorescent tumor tissue by a lacking line of sight between tumor tissue and the microscope. OBJECTIVE To evaluate if an endoscope being capable of inducing fluorescence might overcome some limitations of microscopic fluorescence-guided (FG) resection. METHODS 5-Aminolevulinic acid (20 mg/kg) was given 4 h before surgery. Microsurgical resection of all fluorescent tissue was performed. Then, the resection cavity was scanned with the endoscope. Fluorescent tissue, not being visualized by the microscope, was additionally removed and histopathologically examined separately. Neuronavigation was used for defining the sites of additional tumor resection. All patients underwent magnetic resonance imaging within 48 h after surgery. RESULTS Twenty patients with GBM were operated using microscopic and endoscopic FG resection. In all patients, additional fluorescent tissue was detected with the endoscope. This tissue was completely resected in 19 patients (95%). Eloquent localization precluded complete resection in the remaining patient. In 19 patients (95%), histopathological examination confirmed tumor in the additionally resected tissue. In 19 patients (95%), complete resection was confirmed. In all patients, endoscopic FG resection reached beyond the borders of contrast-enhancing tumor. CONCLUSION Endoscopic FG resection of GBM allows increasing the complete resection rate substantially and therefore is a useful adjunct to microscopic FG resection.

Anterior Skull Base Meningioma: Surgical approach and complication avoidance

2022 ◽  
Author(s):  
Bhawan Nangarwal ◽  
Jaskaran Singh Gosal ◽  
Kuntal Kanti Das ◽  
Deepak Khatri ◽  
Kamlesh Singh Bhaisora ◽  
...  
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Vascular Complications ◽  
Good Alternative ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Medical Complication ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Skull Base Meningioma

Background: Endoscopic endonasal approach (EEA) and keyhole transcranial approaches are being increasingly used in anterior skull base meningioma (ASBM) surgery. Objective: We compare tumor resection rates and complication profiles of EEA and supraorbital key hole approach (SOKHA) against conventional transcranial approaches (TCA). Methods: Fifty-four patients with ASBM [olfactory groove (OGM), n=19 and planum sphenoidale/tuberculum sellae (PS/TSM), n=35) operated at a single centre over 7 years were retrospectively analyzed. Results: The overall rate of GTR was higher in OGM (15/19, 78.9%) than PS-TSM group (23/35, 65.7%, p=0.37). GTR rate with OGM was 90% and 75% with TCA and EEA. Death (n=1) following medical complication (TCA) and CSF leak requiring re-exploration (n=2, one each in TCA and EEA) accounted for the major complications in OGM. For the PS/TSM group, the GTR rates were 73.3% (n=11/15), 53.8% (n=7/13) and 71.4% (n=5/7) with TCA, EEA and SOKHA respectively. Seven patients (20%) of PS-TSM developed major postoperative complications including 4 deaths (one each in TCA, SOKHA and 2 in EEA group) and 3 visual deteriorations. Direct and indirect vascular complications were common in lesser invasive approaches to PS-TSM especially if the tumor has encased intracranial arteries. Conclusions: No single approach is applicable to all ASBMs. TCA is still the best approach to obtain GTR but has tissue trauma related problems. SOKHA may be a good alternative to TCA in selected PS-TSMs while EEA may be an alternate option in some OGMs. A meticulous patient selection is needed to derive reported results of EEA for PS-TSM.

scholarly journals Is fluorescein-guided technique able to help in resection of high-grade gliomas?

2014 ◽  
Vol 36 (2) ◽  
pp. E5 ◽  
Author(s):  
Francesco Acerbi ◽  
Morgan Broggi ◽  
Marica Eoli ◽  
Elena Anghileri ◽  
Claudio Cavallo ◽  
...  
Keyword(s):  
Present Report ◽  
Tumor Resection ◽  
Complete Resection ◽  
High Rate ◽  
Long Term Results ◽  
High Grade ◽  
Clinical Trial Registration ◽  
Surgical Microscope ◽  
Contrast Enhanced ◽  
High Grade Gliomas

Object Fluorescein, a dye that is widely used as a fluorescent tracer, accumulates in cerebral areas where the blood-brain barrier is damaged. This quality makes it an ideal dye for the intraoperative visualization of high-grade gliomas (HGGs). The authors report their experience with a new fluorescein-guided technique for the resection of HGGs using a dedicated filter on the surgical microscope. Methods The authors initiated a prospective Phase II trial (FLUOGLIO) in September 2011 with the objective of evaluating the safety of fluorescein-guided surgery for HGGs and obtaining preliminary evidence regarding its efficacy for this purpose. To be eligible for participation in the study, a patient had to have suspected HGG amenable to complete resection of the contrast-enhancing area. The present report is based on the analysis of the short- and long-term results in 20 consecutive patients with HGGs (age range 45–74 years), enrolled in the study since September 2011. In all cases fluorescein (5–10 mg/kg) was injected intravenously after intubation. Tumor resection was performed with microsurgical technique and fluorescence visualization by means of BLUE 400 or YELLOW 560 filters on a Pentero microscope. Results The median preoperative tumor volume was 30.3 cm3 (range 2.4–87.8 cm3). There were no adverse reactions related to fluorescein administration. Complete removal of contrast-enhanced tumor was achieved in 80% of the patients. The median duration of follow-up was 10 months. The 6-months progression-free survival rate was 71.4% and the median survival was 11 months. Conclusions Analysis of these 20 cases suggested that fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows a high rate of complete resection of contrast-enhanced tumor as determined on early postoperative MRI. Clinical trial registration no.: 2011-002527-18 (EudraCT).

scholarly journals Quantification of Protoporphyrin IX Accumulation in Glioblastoma Cells: A New Technique

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Johnathan E. Lawrence ◽  
Ashish S. Patel ◽  
Richard A. Rovin ◽  
Robert J. Belton ◽  
Catherine E. Bammert ◽  
...  
Keyword(s):  
Cell Line ◽  
Fluorescent Protein ◽  
Aminolevulinic Acid ◽  
Yellow Fluorescent Protein ◽  
Protoporphyrin Ix ◽  
Cell Number ◽  
Neoplastic Tissue ◽  
A New Technique ◽  
Human Gbm

Introduction. 5-Aminolevulinic Acid (5-ALA) is a precursor of heme synthesis. A metabolite, protoporphyrin IX (PpIX), selectively accumulates in neoplastic tissue including glioblastoma. Presurgical administration of 5-ALA forms the basis of fluorescence-guided resection (FGR) of glioblastoma (GBM) tumors. However, not all gliomas accumulate sufficient quantities of PpIX to fluoresce, thus limiting the utility of FGR. We therefore developed an assay to determine cellular and pharmacological factors that impact PpIX fluorescence in GBM. This assay takes advantage of a GBM cell line engineered to express yellow fluorescent protein. Methods. The human GBM cell line U87MG was transfected with a YFP expression vector. After treatment with a series of 5-ALA doses, both PpIX and YFP fluorescence were measured. The ratio of PpIX to YFP fluorescence was calculated. Results. YFP fluorescence permitted the quantification of cell numbers and did not interfere with 5-ALA metabolism. The PpIX/YFP fluorescence ratio provided accurate relative PpIX levels, allowing for the assessment of PpIX accumulation in tissue. Conclusion. Constitutive YFP expression strongly correlates with cell number and permits PpIX quantification. Absolute PpIX fluorescence alone does not provide information regarding PpIX accumulation within the cells. Our research indicates that our PpIX/YFP ratio assay may be a promising model for in vitro 5-ALA testing and its interactions with other compounds during FGR surgery.

scholarly journals Introduction: surgical management of skull base meningiomas

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. Intro ◽  
Author(s):  
Gabriel Zada ◽  
Mustafa K Başkaya ◽  
Mitesh V. Shah
Keyword(s):  
Skull Base ◽  
Wide Spectrum ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae ◽  
Skull Base Meningiomas

Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency.In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors. Along with key pearls for safe tumor resection, an equally important component of open and endoscopic skull base operations for meningiomas addressed by the contributing authors is the reconstruction aspect, which must be performed meticulously to prevent delayed cerebrospinal fluid leakage and/or infections. This curated assortment of instructional videos represents the authors’ optimal treatment paradigms pertaining to the selection of approach, setup, exposure, and principles to guide tumor resection for a wide spectrum of complex meningiomas.

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