5-氨基酮戊酸荧光引导手术对脑膜瘤切除术范围的影响——特别关注高级别肿瘤。
Impact of 5-aminolevulinic acid fluorescence-guided surgery on the extent of resection of meningiomas--with special regard to high-grade tumors.
机构信息
Department of Neurosurgery, University Hospital, Heinrich Heine Universität, Düsseldorf, Germany.
Department of Neurosurgery, University Hospital, Heinrich Heine Universität, Düsseldorf, Germany.
出版信息
Photodiagnosis Photodyn Ther. 2014 Dec;11(4):481-90. doi: 10.1016/j.pdpdt.2014.07.008. Epub 2014 Aug 10.
BACKGROUND AND OBJECTIVES
In high-grade meningiomas and a subgroup of clinically aggressive benign meningiomas tumor control is still insufficient. Recently 5-ALA fluorescence in meningiomas was reported. The impact of 5-ALA fluorescence-guided surgery (FGS) on surgical decision-making and extent of resection has not yet been systematically analyzed, especially not in high-grade meningiomas. The present study deals with three main questions regarding 5-ALA FGS in meningiomas: to assess the potential for discriminating different WHO grades intra-operatively, to analyze the influence on surgical strategy and to evaluate the impact on extent of resection.
METHODS
Data from 31 meningiomas operated with 5-ALA FGS were retrospectively analyzed. Intraoperative fluorescence was graded by the surgeon as "no", "low" or "high". Correlations between semi-quantitative fluorescence and histological features (WHO grade) were analyzed. The influence of 5-ALA fluorescence on surgical strategy and the impact of 5-ALA FGS on degree of resection (Simpson grade and post-operative imaging) were studied. In tumors showing infiltrative growth the extent of resection of fluorescence positive tissue was evaluated.
RESULTS
The population comprised 19 WHO grade I, 8 grade II and 4 grade III tumors (61% benign and 39% high-grade meningiomas). 94% of the tumors showed positive fluorescence. Different fluorescence intensities were observed: "no" in two, "high" in 12 and "low" in 17 tumors, respectively. A significant correlation between fluorescence intensity and WHO grade was found (ρ=0.557, p=0.001). 5-ALA improved the extent of resection in 3/16 (19%) of grade I and in 6/8 (75%) of grade II/III meningiomas. This improvement was not measurable by the Simpson grading as rated by the surgeon and controlled on post-operative imaging.
CONCLUSIONS
In the present population a strong correlation between fluorescence intensity and WHO grade was observed. 5-ALA FGS improved the extent of resection in meningiomas. Especially in high-grade tumors additional information on brain and neurovascular infiltration was provided. The improved resection was not measurable by Simpson's grading necessitating an additional item, which rates residual fluorescence. Long-term studies are necessary to evaluate a possible impact of FGS on recurrence and overall survival.
背景与目的
在高级别脑膜瘤和部分侵袭性良性脑膜瘤中，肿瘤控制仍然不足。最近，脑膜瘤中的 5-ALA 荧光已被报道。5-ALA 荧光引导手术（FGS）对手术决策和切除范围的影响尚未得到系统分析，特别是在高级别脑膜瘤中。本研究主要涉及三个关于脑膜瘤中 5-ALA FGS 的问题：评估术中鉴别不同 WHO 级别的潜力，分析对手术策略的影响，并评估对切除范围的影响。
方法
回顾性分析了 31 例采用 5-ALA FGS 手术的脑膜瘤患者的数据。术中医师将术中荧光分级为“无”、“低”或“高”。分析半定量荧光与组织学特征（WHO 分级）之间的相关性。研究了 5-ALA 荧光对手术策略的影响以及 5-ALA FGS 对切除程度（Simpson 分级和术后影像学）的影响。在表现为浸润性生长的肿瘤中，评估荧光阳性组织的切除程度。
结果
该人群包括 19 例 WHO 分级 I 级、8 例分级 II 级和 4 例分级 III 级肿瘤（61%为良性，39%为高级别脑膜瘤）。94%的肿瘤呈阳性荧光。观察到不同的荧光强度：无 2 例，高 12 例，低 17 例。荧光强度与 WHO 分级之间存在显著相关性（ρ=0.557，p=0.001）。在 16 例 I 级脑膜瘤中，5-ALA 提高了 3 例（19%），在 8 例 II/III 级脑膜瘤中提高了 6 例（75%）的切除程度。这种改善无法通过术中医师评估和术后影像学控制的 Simpson 分级来衡量。
结论
在本研究人群中，荧光强度与 WHO 分级之间存在很强的相关性。5-ALA FGS 提高了脑膜瘤的切除程度。特别是在高级别肿瘤中，提供了关于脑和神经血管浸润的额外信息。改善的切除程度无法通过 Simpson 的分级来衡量，需要增加一个评分残余荧光的项目。需要进行长期研究以评估 FGS 对复发和总体生存率的可能影响。
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