Behling Felix, Hennersdorf Florian, Bornemann Antje, Tatagiba Marcos, Skardelly Marco
Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany.
Department of Neuroradiology, Eberhard-Karls-University, Tübingen, Germany.
World Neurosurg. 2016 Aug;92:586.e5-586.e8. doi: 10.1016/j.wneu.2016.05.009. Epub 2016 May 10.
5-Aminolevulinic acid (5-ALA) has become an integral part in the neurosurgical treatment of malignant glioma. Over time, several other tumor entities have been identified to metabolize 5-ALA and show a similar fluorescence pattern during surgical resection. This case report is the first description of 5-ALA accumulation in postischemic cerebral tissue. This evidence questions the assumption that 5-ALA accumulation in glioma is exclusively attributed to tumor infiltration. Instead, 5-ALA accumulation can also occur beyond the tumor borders and may be partially ascribed to inflammatory changes in the surrounding brain tissue.
A 64-year old woman presented with episodes of apraxia and a ring-enhancing lesion in postcontrast T1-weighted magnetic resonance sequences suggestive of high grade glioma. Strong fluorescence was observed during 5-ALA-guided resection. However, although the frozen section was inconclusive, the final histopathologic examination revealed a stage II cerebral infarction.
5-ALA accumulation in postischemic cerebral tissue should be considered for intended supramarginal resections near eloquent brain regions. Therefore, sufficient preoperative imaging should regularly include magnetic resonance imaging spectroscopy and perfusion sequences to ascertain the proper diagnosis. Moreover, further research is warranted to determine the role of 5-ALA accumulation in postischemic and inflammatory brain tissue.
5-氨基乙酰丙酸（5-ALA）已成为恶性胶质瘤神经外科治疗中不可或缺的一部分。随着时间的推移，已发现其他几种肿瘤实体可代谢5-ALA，并在手术切除过程中表现出相似的荧光模式。本病例报告首次描述了5-ALA在缺血后脑组织中的蓄积。这一证据对5-ALA在胶质瘤中蓄积仅归因于肿瘤浸润这一假设提出了质疑。相反，5-ALA蓄积也可能发生在肿瘤边界之外，并且可能部分归因于周围脑组织的炎症变化。
一名64岁女性出现失用发作，在增强后T1加权磁共振序列中可见环形强化病变，提示高级别胶质瘤。在5-ALA引导的切除术中观察到强烈荧光。然而，尽管冰冻切片结果不明确，但最终组织病理学检查显示为II期脑梗死。
对于在脑功能区附近进行的超边缘切除术，应考虑5-ALA在缺血后脑组织中的蓄积。因此，充分的术前影像学检查应常规包括磁共振波谱成像和灌注序列，以确定正确诊断。此外，有必要进一步研究以确定5-ALA在缺血性和炎性脑组织中蓄积的作用。
