Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Central Nervous System Tumours Unit, Comprehensive Cancer Center, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria.
Neurosurgery. 2020 Mar 1;86(3):366-373. doi: 10.1093/neuros/nyz086.
Intraoperative histopathology and acquisition of multiple tissue samples in stereotactic biopsies results in a prolonged length of surgery and potentially increased complication rate.
To investigate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with the assistance of 5-aminolevulinic acid (5-ALA) induced fluorescence.
Patients that received 5-ALA prior to stereotactic biopsy of a suspected brain tumor were included. According to our strategy, the procedure was terminated in the case of strong fluorescence of the biopsy samples. In contrast, intraoperative histology was demanded in the case of vague/no fluorescence. Length of surgery, number of biopsy samples, diagnostic rate, and periprocedural complications were compared between these 2 groups.
Altogether, 79 patients were included, and strong fluorescence was present in 62 cases (79%), vague fluorescence was in 4 cases (5%), and no fluorescence was in 13 cases (16%). The diagnostic rate was comparable in biopsies with strong fluorescence without intraoperative histopathology and cases with vague/no fluorescence with intraoperative histopathology (98% vs 100%; P = 1.000). A significantly shorter length of surgery (41 vs 77 min; P < .001) and reduced average number of biopsy samples (3.6 vs 4.9; P = .011) was found in patients with strong compared to vague/no fluorescence. However, no statically significant difference in periprocedural complications between cases with strong and vague/no fluorescence was found (7% vs 18%; P = .166).
Our data demonstrate the clinical benefits of a novel strategy for stereotactic brain tumor biopsies with assistance of 5-ALA. Thus, this biopsy strategy will increase the efficiency of this standard neurosurgical procedure in the future.
立体定向活检术中的组织病理学检查和获取多个组织样本会导致手术时间延长，并可能增加并发症发生率。
研究新型立体定向脑肿瘤活检策略在 5-氨基酮戊酸（5-ALA）诱导荧光辅助下的临床获益。
纳入接受 5-ALA 预处理后行疑似脑肿瘤立体定向活检的患者。根据我们的策略，如果活检样本的荧光强，则手术终止；如果荧光弱/无，则要求进行术中组织学检查。比较两组患者的手术时间、活检样本数量、诊断率和围手术期并发症。
共纳入 79 例患者，62 例（79%）活检样本荧光强，4 例（5%）荧光弱，13 例（16%）荧光无。荧光强且无术中组织学检查与荧光弱/无且有术中组织学检查的活检诊断率相当（98%比 100%；P=1.000）。与荧光弱/无的患者相比，荧光强的患者手术时间明显更短（41 分钟比 77 分钟；P<.001），活检样本平均数量更少（3.6 个比 4.9 个；P=.011）。然而，荧光强与荧光弱/无的患者之间的围手术期并发症发生率无统计学差异（7%比 18%；P=.166）。
我们的数据表明，5-ALA 辅助新型立体定向脑肿瘤活检策略具有临床获益。因此，这种活检策略将提高未来标准神经外科手术的效率。
