Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Neurol India. 2011 Jul-Aug;59(4):612-5. doi: 10.4103/0028-3886.84349.
Hemangioblastoma is a benign tumor of the cerebellum, and treatment involves surgical excision, both as the initial treatment and also in case of recurrence. Recurrence of hemangioblastoma can be local due to incomplete resection or can be distant and separate from the tumor resection region. Local recurrence can largely be avoided by verifying for any residual tumor intraoperatively before closure. In this study, we used intraoperative fluorescent diagnosis using 5-aminolevulinic acid (5-ALA) to verify the presence of a residual tumor during surgical resection. Nine patients with hemangioblastoma were given 1 g of 5-ALA orally before surgery, and a laser beam of 405 nm was focused on the tumor during resective surgery. Fluorescence of protoporphyrin IX (PPIX) was observed in the core of tumor in all the cases. Fluorescence of PPIX was observed in the peritumoral cyst wall in two patients after tumor resection, and in both of them fluorescent parts of PPIX were resected and histological examination showed tumor cells. Usually, there are no tumor cells in the peritumoral cyst of a hemangioblastoma, yet hemangioblastomas may sometimes recur from an unresected cyst wall. It is thus necessary to excise an infiltrating cyst of tumor cells to prevent recurrence. Intraoperative fluorescent diagnosis using 5-ALA is a useful method to discern whether tumor cells are present in the peritumoral cyst wall of a hemangioblastoma.
血管母细胞瘤是小脑的良性肿瘤，治疗包括手术切除，既是初始治疗也是复发时的治疗方法。血管母细胞瘤的复发可以是局部的，由于不完全切除，也可以是远处的，与肿瘤切除区域分离。通过在关闭前术中验证任何残留肿瘤，可以在很大程度上避免局部复发。在这项研究中，我们使用术中荧光诊断用 5-氨基酮戊酸（5-ALA）来验证手术切除过程中是否存在残留肿瘤。9 名血管母细胞瘤患者在手术前口服 1 g 5-ALA，在切除手术过程中，将 405nm 的激光束聚焦在肿瘤上。在所有病例中，都观察到原卟啉 IX（PPIX）的荧光在肿瘤核心处。在肿瘤切除后，两名患者的瘤周囊壁上观察到 PPIX 的荧光，在这两名患者中，均切除了荧光部分的 PPIX，组织学检查显示有肿瘤细胞。通常情况下，血管母细胞瘤的瘤周囊中没有肿瘤细胞，但血管母细胞瘤有时可能从未切除的囊壁复发。因此，有必要切除肿瘤细胞浸润的囊壁以防止复发。术中使用 5-ALA 进行荧光诊断是一种有用的方法，可以辨别血管母细胞瘤瘤周囊壁中是否存在肿瘤细胞。
