Ivanidze Jana, Rosen Kate, Zgaljardic Michael, Lawrence Jesse D, Forader Beth Ann, Konner Marcus, Liechty Benjamin, Watson Alexis, Pannullo Susan C, Green Elizabeth, Knisely Jonathan P S, Karakatsanis Nicolas A, Nehmeh Sadek A, Schwartz Theodore H
Department of Radiology, Weill Cornell Medicine, New York, New York.
Department of Neurological Surgery, Weill Cornell Medicine, New York, New York.
J Neurosurg Case Lessons. 2025 Mar 24;9(12). doi: 10.3171/CASE24867.
Meningiomas are the most common primary intracranial neoplasms. Gross-total resection, the primary treatment goal, is not achieved in up to 50% of patients, affecting progression-free and overall survival. The traditionally used intraoperative assessment of resection extent using the Simpson grade has recently been shown to be less accurate than postoperative MRI. Improving intraoperative resection extent delineation thus represents a paramount goal. Somatostatin receptor (SSTR)-targeted PET has improved meningioma management. [Cu64]DOTATATE is a clinically approved PET radiotracer that avidly binds to SSTR2 with properties similar to [Ga68]DOTATATE but with a significantly longer half-life of approximately 13 hours.
The authors assessed the feasibility of immediate preoperative [Cu64]DOTATATE PET/MRI and subsequent intraoperative tumor detection using a handheld gamma probe device typically used in sentinel node biopsy. They describe [Cu64]DOTATATE PET-guided surgical debulking of a meningioma and demonstrate the feasibility of intraoperative tumor detection using the gamma probe device, with activity 10 times higher than the background after exposing the tumor, decreasing by 50% after debulking. The authors further demonstrate 3-month clinical and PET/MRI outcomes, with accurate delineation of minimal residual viable tumor.
This pilot study for the first time demonstrates the feasibility of preoperative PET with in vivo radio-guided surgery in meningiomas, laying the foundation for larger-scale prospective trials. https://thejns.org/doi/10.3171/CASE24867.
脑膜瘤是最常见的原发性颅内肿瘤。作为主要治疗目标的肿瘤全切除，在高达50%的患者中无法实现，这会影响无进展生存期和总生存期。最近研究表明，传统上术中使用辛普森分级评估切除范围不如术后MRI准确。因此，提高术中切除范围的界定是一个至关重要的目标。靶向生长抑素受体（SSTR）的PET改善了脑膜瘤的治疗。[铜64] DOTATATE是一种临床批准的PET放射性示踪剂，它与SSTR2紧密结合，其特性与[镓68] DOTATATE相似，但半衰期明显更长，约为13小时。
作者评估了术前即刻进行[铜64] DOTATATE PET/MRI以及随后使用前哨淋巴结活检中常用的手持式γ探针装置进行术中肿瘤检测的可行性。他们描述了[铜64] DOTATATE PET引导下的脑膜瘤手术减瘤情况，并证明了使用γ探针装置进行术中肿瘤检测的可行性，暴露肿瘤后其活性比背景高10倍，减瘤后降低50%。作者进一步展示了3个月的临床和PET/MRI结果，准确界定了最小残留存活肿瘤。
这项初步研究首次证明了术前PET联合体内放射性引导手术在脑膜瘤治疗中的可行性，为大规模前瞻性试验奠定了基础。https://thejns.org/doi/10.3171/CASE24867。
