5-氨基酮戊酸诱导荧光与术中磁共振成像引导手术治疗脑胶质瘤的效果。

Impact of the combination of 5-aminolevulinic acid-induced fluorescence with intraoperative magnetic resonance imaging-guided surgery for glioma.

机构信息

Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan.

出版信息

World Neurosurg. 2011 Jul-Aug;76(1-2):120-7. doi: 10.1016/j.wneu.2011.02.005.

DOI:10.1016/j.wneu.2011.02.005

PMID:21839963

Abstract

OBJECTIVE

To compare intraoperative magnetic resonance imaging (MRI)-guided resection with resection guided by 5-aminolevulinic acid (5-ALA)-induced fluorescence in patients with gliomas and to evaluate the impact of intraoperative MRI in glioma surgery.

METHODS

From January 2005 to February 2009, 33 patients with gliomas (6 with World Health Organization [WHO] grade II, 7 with WHO grade III, 20 with WHO grade IV) who underwent craniotomy with neuronavigation and received 5-ALA by the same neurosurgeon were investigated retrospectively. In 19 patients, operations were performed using a combination of 5-ALA with intraoperative 1.5-T MRI. All patients were subjected to postoperative 1.5-T MRI to confirm the extent of resection.

RESULTS

Of 33 patients with gliomas, 21 (4 with WHO grade III and 17 with WHO grade IV) were 5-ALA-induced fluorescence-positive (5-ALA (+)). Surgery with intraoperative MRI was performed in 10 of the 21 patients, and the average resection rate was 92.6%. The average resection rate of patients who underwent surgery without intraoperative MRI was 91.8%. 5-ALA-induced fluorescence was not detected in 12 patients (6 with WHO grade II, 3 with WHO grade III, and 3 with WHO grade IV) with gliomas. Surgery with intraoperative MRI was performed in 9 of 12 patients, and the average resection rate was 89.2%. The average resection rate of patients who underwent surgery without intraoperative MRI was 68.7%. Intraoperative MRI-guided tumor resection resulted in a better resection rate in patients with 5-ALA-induced fluorescence-negative (5-ALA (-)) gliomas than in patients with 5-ALA (+) gliomas (20.5% vs 0.8%).

CONCLUSIONS

Intraoperative MRI-guided resection is a powerful tool to treat 5-ALA (-) gliomas (mostly low grade), and 5-ALA is useful for high-grade gliomas. The combination of intraoperative MRI and 5-ALA has a synergistic effect in glioma surgery. Additionally, precise tumor grading in preoperative imaging studies can be difficult. Surgery for gliomas should be performed using both 5-ALA-induced fluorescence and intraoperative MRI-guided resection.

摘要

目的

比较术中磁共振成像（MRI）引导切除与 5-氨基酮戊酸（5-ALA）诱导荧光引导切除在胶质瘤患者中的应用，并评估术中 MRI 在胶质瘤手术中的影响。

方法

回顾性分析 2005 年 1 月至 2009 年 2 月间 33 例接受神经导航开颅手术和同一位神经外科医生使用 5-ALA 的胶质瘤患者。其中 6 例为世界卫生组织（WHO）Ⅱ级，7 例为 WHO Ⅲ级，20 例为 WHO Ⅳ级。19 例患者术中联合使用 5-ALA 和 1.5-T MRI。所有患者均在术后接受 1.5-T MRI 以确认切除范围。

结果

33 例胶质瘤患者中，21 例（4 例为 WHO Ⅲ级，17 例为 WHO Ⅳ级）为 5-ALA 诱导荧光阳性（5-ALA（+））。其中 10 例行术中 MRI 手术，平均切除率为 92.6%。未行术中 MRI 手术的患者平均切除率为 91.8%。12 例（6 例为 WHO Ⅱ级，3 例为 WHO Ⅲ级，3 例为 WHO Ⅳ级）胶质瘤患者 5-ALA 诱导荧光未检出。其中 9 例行术中 MRI 手术，平均切除率为 89.2%。未行术中 MRI 手术的患者平均切除率为 68.7%。术中 MRI 引导肿瘤切除可提高 5-ALA 诱导荧光阴性（5-ALA（-））胶质瘤患者的切除率，优于 5-ALA（+）胶质瘤患者（20.5%比 0.8%）。