Matsuda Masahide, Sugii Narushi, Sakamoto Noriaki, Yamano Akinari, Ishikawa Eiichi
Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan.
Cancers (Basel). 2025 Mar 31;17(7):1191. doi: 10.3390/cancers17071191.
In cases of intracranial meningiomas invading into surrounding tissues, determining the resection boundary can be challenging and often makes complete resection difficult. In such situations, the introduction of novel intraoperative techniques to identify infiltrative tumor components is desirable to improve the extent of tumor resection.
A prospective clinical study was conducted on patients with intracranial meningiomas suspected of infiltration into the surrounding tissues. After completing the tumor resection under conventional white-light microscopy, intraoperative fluorescence diagnosis using 5-aminolevulinic acid (5-ALA) was performed to determine whether additional resection of the unintended residual tumor was feasible.
Intraoperative fluorescence diagnosis enabled additional resection of the residual tumor in 38.5% of the 13 enrolled cases and 45.5% of the 11 cases in which the tumor exhibited fluorescence positivity. Among the additional resected specimens, tumor infiltration was observed in all fluorescence-positive lesions of the bone and dura mater, whereas tumor cells were detected in only 33.3% of the fluorescence-positive areas in the adjacent brain parenchyma.
Intraoperative fluorescence diagnosis using 5-ALA enhanced the extent of the resection of invasive meningiomas. Future large-scale studies are warranted to determine whether 5-ALA fluorescence diagnosis contributes to reducing tumor recurrence and improving overall survival in patients with invasive intracranial meningiomas.
在颅内脑膜瘤侵犯周围组织的病例中，确定切除边界可能具有挑战性，并且常常使完全切除变得困难。在这种情况下，引入新的术中技术来识别浸润性肿瘤成分有助于提高肿瘤切除范围。
对怀疑浸润周围组织的颅内脑膜瘤患者进行了一项前瞻性临床研究。在常规白光显微镜下完成肿瘤切除后，使用5-氨基酮戊酸（5-ALA）进行术中荧光诊断，以确定是否可行额外切除意外残留肿瘤。
术中荧光诊断使13例入组病例中的38.5%以及11例肿瘤表现为荧光阳性的病例中的45.5%能够额外切除残留肿瘤。在额外切除的标本中，在所有骨和硬脑膜的荧光阳性病变中均观察到肿瘤浸润，而在相邻脑实质的荧光阳性区域中仅33.3%检测到肿瘤细胞。
使用5-ALA进行术中荧光诊断提高了侵袭性脑膜瘤的切除范围。未来有必要进行大规模研究，以确定5-ALA荧光诊断是否有助于降低侵袭性颅内脑膜瘤患者的肿瘤复发率并改善总生存期。
