Potapov A A, Goryaynov S A, Danilov G V, Chelushkin D M, Okhlopkov V A, Shimanskiy V N, Beshplav Sh T, Poshataev V K, Shishkina L V, Zakharova N E, Spallone A, Savel'eva T A, Loshchenov V B
Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047.
Department of Biomedicine, University of Rome Tor Vergata and NCL-Institute of Neurological Sciences, Rome, Italy; Neurological Center of Latium, Via Patrica 15, Rome, 00178, Italy.
Zh Vopr Neirokhir Im N N Burdenko. 2018;82(2):17-29. doi: 10.17116/oftalma201882217-29.
Fluorescence diagnostics has been extensively applied in surgery of malignant brain gliomas. However, the use of this technique in surgery of intracranial meningiomas has remained controversial.
The study objective was to assess the sensitivity of 5-aminolevulinic acid-based (5-ALA) fluorescence diagnostics in surgery of brain meningiomas and to clarify the clinical and biological factors that may influence the fluorescent effect.
The study consistently included 101 patients with intracranial meningiomas of various locations who were operated on using 5-ALA. There were 28 (27.72%) males and 73 (72.27%) females (median age, 54 years). In all patients, surgery was performed using an operating microscope equipped with a fluorescent module; in 24 of these, laser spectroscopy was used. For comparison of chances to observe the fluorescent effect of 5-ALA in patients having meningiomas with different WHO histological grades (Grade I vs Grade II-III), we performed a meta-analysis that included 10 studies (the largest series) on outcomes of surgical treatment of meningiomas using intraoperative fluorescence diagnostics.
Of 101 patients included in this series, observable fluorescence was detected in 95 (94.1%) patients: weak fluorescence in 12 (11.9%), moderate fluorescence in 23 (22.8%) cases, and strong fluorescence in 60 (59.4%) patients. There was no statistically significant relationship (p>0.05) between the rate and intensity of observable fluorescence and the tumor growth pattern (primary/continued), location, WHO grade of malignancy, and histological subtype. In the absence of intraoperative bleeding, tumor fluorescence was statistically significantly brighter (p=0.02). Of 26 patients with hyperostosis, bone fluorescence was observed in 11 (42.3%) cases. There was no statistically significant relationship between administration of dexamethasone, its dose, administration of anticonvulsants, gastrointestinal tract diseases, as well as diabetes mellitus and the fluorescence intensity. There was also no significant relationship between the extent of tumor resection (Simpson scale) and the presence of fluorescence as well as its intensity. Comparison of the observable fluorescence intensity and the laser spectroscopy indicators revealed a significant correlation (r=0.75; p=0.005).
Meningioma is a well fluorescent tumor, with the technique sensitivity being 94.1%. In some cases, the use of fluorescence diagnostics in surgery of meningiomas improves identification of residual tumor fragments and enables correction of a surgical approach. To assess the effect of fluorescence diagnostics on the recurrence rate and disease-free duration, further research is required.
荧光诊断已广泛应用于恶性脑胶质瘤手术。然而，该技术在颅内脑膜瘤手术中的应用仍存在争议。
本研究旨在评估基于5-氨基酮戊酸（5-ALA）的荧光诊断在脑膜瘤手术中的敏感性，并阐明可能影响荧光效果的临床和生物学因素。
本研究持续纳入101例不同部位颅内脑膜瘤患者，均采用5-ALA进行手术。其中男性28例（27.72%），女性73例（72.27%）（中位年龄54岁）。所有患者均使用配备荧光模块的手术显微镜进行手术；其中24例使用了激光光谱分析。为比较不同世界卫生组织（WHO）组织学分级（I级与II-III级）的脑膜瘤患者观察到5-ALA荧光效果的几率，我们进行了一项荟萃分析，纳入了10项关于术中荧光诊断用于脑膜瘤手术治疗结果的研究（最大系列）。
本系列纳入的101例患者中，95例（94.1%）检测到可观察到的荧光：12例（11.9%）为弱荧光，23例（22.8%）为中度荧光，60例（59.4%）为强荧光。可观察到的荧光发生率和强度与肿瘤生长方式（原发性/持续性）、位置、WHO恶性分级及组织学亚型之间无统计学显著相关性（p>0.05）。在无术中出血的情况下，肿瘤荧光在统计学上显著更亮（p=0.02）。26例有骨质增生的患者中，11例（42.3%）观察到骨质荧光。地塞米松的使用、其剂量、抗惊厥药物的使用、胃肠道疾病以及糖尿病与荧光强度之间无统计学显著相关性。肿瘤切除范围（辛普森分级）与荧光的存在及其强度之间也无显著相关性。可观察到的荧光强度与激光光谱分析指标的比较显示出显著相关性（r=0.75；p=0.005）。
脑膜瘤是一种荧光良好的肿瘤，该技术敏感性为94.1%。在某些情况下，脑膜瘤手术中使用荧光诊断可改善对残留肿瘤碎片的识别，并有助于调整手术方法。为评估荧光诊断对复发率和无病生存期的影响，还需要进一步研究。
