Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48147, Münster, Germany.
Acta Neurochir (Wien). 2020 Feb;162(2):365-372. doi: 10.1007/s00701-019-04144-4. Epub 2019 Nov 21.
Fluorescence in the ventricular wall or the ependyma during fluorescence-guided resection (FGR) of malignant glioma is commonly observed when malignant gliomas infiltrate the ventricles. However, the underlying pathophysiology and clinical importance are largely unknown but may play a role in deciding whether to continue resection into the ventricles or not. Here, we systematically review available data regarding ependymal fluorescence in FGR using five aminolevulinic acid (5-ALA) and sodium fluorescein (SF).
A literature search on MEDLINE, EMBASE, and WEB OF SCIENCE was performed using the following headings and search operators: ependy* fluorescence AND (5-ALA OR five aminolevulinic acid), ventric* wall fluorescence AND (5-ALA OR five aminolevulinic acid), ependy* fluorescence AND fluorescein, and ventric* wall fluorescence AND fluorescein. Both authors analyzed abstracts independently. Included articles were further reviewed for prevalence of ependymal fluorescence, patterns of fluorescence, and histopathological characteristics of sampled tissues as well as radiological signs of ependymal fluorescence. Results are reported according to the PRISMA statement.
Of 202 records identified, 6 studies were included compiling a total number of 198 patients treated with FGR using 5-ALA. No study on ependymal fluorescence after administration of SF was found. Overall prevalence of ependymal fluorescence was 61.4%. A total of 54.5% of cases were found to be positive for tumor cells. A total of 25.5% of patients with ependymal fluorescence were related to contrast enhancement in ventricular walls.
The phenomenon of ventricular wall fluorescence in 5-ALA-derived fluorescence-guided resection of malignant glioma is poorly understood and not always may fluorescence represent tumor infiltration. A larger scale prospective sampling study with molecular analyses is currently ongoing and will hopefully provide further insight into pathophysiology and clinical implications of ependymal fluorescence.
在恶性神经胶质瘤的荧光引导切除（FGR）过程中，当恶性神经胶质瘤浸润脑室时，通常会观察到心室壁或室管膜的荧光。然而，其潜在的病理生理学和临床重要性在很大程度上是未知的，但可能在决定是否继续向脑室切除中发挥作用。在这里，我们使用五种氨基酮戊酸（5-ALA）和荧光素钠（SF）系统地综述了 FGR 中室管膜荧光的现有数据。
使用以下标题和搜索运算符在 MEDLINE、EMBASE 和 WEB OF SCIENCE 上进行文献检索：ependy荧光 AND（5-ALA 或五种氨基酮戊酸）、ventric壁荧光 AND（5-ALA 或五种氨基酮戊酸）、ependy荧光 AND 荧光素和 ventric壁荧光 AND 荧光素。两位作者独立分析摘要。纳入的文章进一步审查了室管膜荧光的流行率、荧光模式以及采样组织的组织病理学特征以及室管膜荧光的放射学征象。结果根据 PRISMA 声明报告。
在确定的 202 条记录中，有 6 项研究包括使用 FGR 使用 5-ALA 治疗的 198 名患者，共汇总了 198 名患者。未发现关于 SF 给药后室管膜荧光的研究。室管膜荧光的总患病率为 61.4%。发现肿瘤细胞阳性的病例共有 54.5%。共有 25.5%的室管膜荧光患者与心室壁对比增强有关。
在使用 5-ALA 衍生的荧光引导切除恶性神经胶质瘤的过程中，对心室壁荧光现象的了解甚少，并且荧光并不总是代表肿瘤浸润。目前正在进行一项更大规模的前瞻性采样研究，其中包括分子分析，希望能进一步深入了解室管膜荧光的病理生理学和临床意义。
