Neurosurgery, Department NEUROFARBA, University of Florence, Careggi University Hospital, 50141, Florence, Italy.
Pathology Unit, Anna Meyer Children's University Hospital, 50139, Florence, Italy.
Neurol Sci. 2022 Aug;43(8):5075-5082. doi: 10.1007/s10072-022-06012-z. Epub 2022 Mar 25.
The aim of this study is to compare the use of 5-aminolevulinic acid (5-ALA) and sodium fluorescein (SF) in IV ventricular ependymoma (IVEP) surgical resection.
In this retrospective study, six patients with IVEP were enrolled. Gender ratio 2:1 male to female, with mean age 38.9 years old. A 5-ALA oral dose of 20 mg/kg and a SF intravenous dose of 2 mg/kg were administered. Telo-velar approach, operative microscope, and intraoperative monitoring were used in all the operations. We retrospectively compared the two fluorescence techniques at four steps during the surgical procedure: step 1: exposure of the tumor; step 2: dissection of the lesion from the cerebellum; step 3: assessment of the tumor borders and differentiation from normal tissue at the base of implants; and step 4: evaluation of possible residual tissue in the surgical cavity.
At the first step, the ependymomas resulted well delineated by both fluorescent agents. In this step, 5-ALA was particularly helpful in the case of recurrent ependymoma. At step 2, 5-ALA provided a better identification of the ependymoma boundaries and distinction from cerebellum hemispheres than SF. In steps 3 and 4, SF was really helpful to detect tumor tissue.
According to our experience, fluorescence-guided surgery of IVEP with 5-ALA and SF is useful to maximize surgical resection with less risk of brainstem injury. Both fluorescence techniques are helpful in different steps of IVEP resection. However, further studies are needed to confirm our preliminary data.
本研究旨在比较 5-氨基乙酰丙酸（5-ALA）和荧光素钠（SF）在第四脑室室管膜瘤（IVEP）手术切除中的应用。
在这项回顾性研究中，纳入了 6 名 IVEP 患者。男女比例为 2:1，男性平均年龄为 38.9 岁。给予患者 5-ALA 口服剂量 20mg/kg 和 SF 静脉剂量 2mg/kg。所有手术均采用 telo-velar 入路、手术显微镜和术中监测。我们回顾性地比较了两种荧光技术在手术过程中的四个步骤：步骤 1：暴露肿瘤；步骤 2：从小脑分离病变；步骤 3：评估肿瘤边界并区分植入物基底的正常组织；步骤 4：评估手术腔中可能残留的组织。
在第一步中，两种荧光剂均能很好地勾勒出室管膜瘤。在这一步，5-ALA 在复发性室管膜瘤中特别有帮助。在第二步中，5-ALA 比 SF 能更好地识别室管膜瘤边界并与大脑半球区分开来。在步骤 3 和步骤 4 中，SF 非常有助于检测肿瘤组织。
根据我们的经验，使用 5-ALA 和 SF 对 IVEP 进行荧光引导手术有助于最大限度地减少脑干损伤的风险，并进行手术切除。两种荧光技术在 IVEP 切除的不同步骤中都有帮助。然而，需要进一步的研究来证实我们的初步数据。
