Department of Neurosurgery, Westchester Medical Center/New York Medical College, 100 Woods Road, Macy Suite 1332, Valhalla, NY, 10595, USA.
Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
J Neurooncol. 2019 Feb;141(3):575-584. doi: 10.1007/s11060-018-03080-0. Epub 2018 Dec 29.
Primary intradural spinal neoplasms account for a small proportion of central nervous system tumors. The primary treatment for these tumors consists of maximal safe resection and preservation of neurologic function. Gross total resection, which is associated with the lowest rate of tumor recurrence and longer progression-free survival for most histologies, can be difficult to achieve. Currently, the use of 5-aminolevulinc acid (5-ALA) which takes advantage of Protoporphyrin IX (PpIX) fluorescence, is a well-established technique for improving resection of malignant cerebral gliomas. This technique is being increasingly applied to other cerebral neoplasms, and multiple studies have attempted to evaluate the utility of 5-ALA-aided resection of spinal neoplasms.
The authors reviewed the existing literature on the use of 5-ALA and PpIX fluorescence as an aid to resection of primary and secondary spinal neoplasms by searching the PUBMED and EMBASE database for records up to March 2018. Data was abstracted from all studies describing spinal neurosurgical uses in the English language.
In the reviewed studies, the most useful fluorescence was observed in meningiomas, ependymomas, drop metastases from cerebral gliomas, and hemangiopericytomas of the spine, which is consistent with applications in cerebral neoplasms.
The available literature is significantly limited by a lack of standardized methods for measurement and quantification of 5-ALA fluorescence. The results of the reviewed studies should guide future development of rational trial protocols for the use of 5-ALA guided resection in spinal neoplasms.
原发性硬脊膜内脊髓肿瘤在中枢神经系统肿瘤中所占比例较小。这些肿瘤的主要治疗方法是最大限度地安全切除并保留神经功能。大多数组织学类型的肿瘤全切除（即肿瘤复发率最低和无进展生存期最长的肿瘤切除方法）往往难以实现。目前，利用 5-氨基酮戊酸（5-ALA）来增加原卟啉 IX（PpIX）荧光，是提高恶性脑胶质瘤切除率的一种成熟技术。该技术正越来越多地应用于其他脑肿瘤，并且多项研究尝试评估 5-ALA 辅助切除脊髓肿瘤的效用。
作者通过检索 PUBMED 和 EMBASE 数据库，搜索截至 2018 年 3 月的关于 5-ALA 和 PpIX 荧光在原发性和继发性脊髓肿瘤切除中的应用的文献，回顾了 5-ALA 用于辅助切除原发性和继发性脊髓肿瘤的现有文献。从所有描述英语脊髓神经外科应用的研究中提取数据。
在回顾的研究中，脑膜瘤、室管膜瘤、脑胶质瘤的转移瘤和脊柱的血管外皮细胞瘤的荧光最有用，这与脑肿瘤的应用一致。
现有文献的局限性在于缺乏 5-ALA 荧光的标准化测量和量化方法。这些研究的结果应该指导未来制定合理的试验方案，以用于指导脊髓肿瘤的 5-ALA 引导切除。
