Morofuji Yoichi, Matsuo Takayuki, Hayashi Yukishige, Suyama Kazuhiko, Nagata Izumi
Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
Neurosurgery. 2008 Mar;62(3 Suppl 1):102-3; discussion 103-4. doi: 10.1227/01.neu.0000317378.22820.46.
We present a case of a meningioma in which photodynamic diagnosis (PDD) using 5-aminolevulinic acid was very useful in identifying the cranial involvement.
An 83-year-old woman presented with a bony, hard, immobile bulge in her left forehead. Computed tomographic scans showed a thickening in the left frontal bone with a flat mass underneath. Magnetic resonance imaging scans revealed that enhancing lesions spread to the dura mater and subcutaneous tissue around the thickened frontal bone, reaching the upper margin of the left orbit.
Intraoperative PDD using 5-aminolevulinic acid indicated the optimal extent of the excision by showing clear fluorescence of affected tissues. The tumor was totally resected and diagnosed as an atypical meningioma. Histopathological examination confirmed the consistency of the extent of tumor invasion with affected lesions on PDD.
To the best of our knowledge, this is the first case demonstrating the efficacy of PDD using 5-aminolevulinic acid for a meningioma with cranial invasion. Additional studies are warranted, as shown in cases of malignant gliomas.
我们报告一例脑膜瘤病例，其中使用5-氨基酮戊酸的光动力诊断（PDD）在识别颅骨受累方面非常有用。
一名83岁女性，左前额出现一个骨质坚硬、固定不动的隆起。计算机断层扫描显示左额骨增厚，其下方有一个扁平肿块。磁共振成像扫描显示强化病变蔓延至增厚额骨周围的硬脑膜和皮下组织，到达左眼眶上缘。
术中使用5-氨基酮戊酸进行PDD，通过显示受影响组织的清晰荧光来指示切除的最佳范围。肿瘤被完全切除，诊断为非典型脑膜瘤。组织病理学检查证实肿瘤侵袭范围与PDD上受影响病变一致。
据我们所知，这是首例证明使用5-氨基酮戊酸的PDD对伴有颅骨侵袭的脑膜瘤有效的病例。正如恶性胶质瘤病例所示，有必要进行更多研究。
