The current status of 5-ALA fluorescence-guided resection of intracranial meningiomas-a critical review

Arash Motekallemi, Hanne-Rinck Jeltema, Jan D. M. Metzemaekers, Gooitzen M. van Dam, Lucy M. A. Crane, Rob J. M. Groen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. In the present paper, we review the existing literature about the application of 5-ALA as an intraoperative tool for the resection of intracranial meningiomas. PubMed was used as the database for search tasks. We included articles published in English without limitations regarding publication date. Tumor fluorescence can occur in benign meningiomas (WHO grade I) as well as in WHO grade II and WHO grade III meningiomas. Most of the reviewed studies report fluorescence of the main tumor mass with high sensitivity and specificity. However, different parts of the same tumor can present with a different fluorescent pattern (heterogenic fluorescence). Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility. However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.

Original languageEnglish
Pages (from-to)619-628
Number of pages10
JournalNeurosurgical review
Volume38
Issue number4
DOIs
Publication statusPublished - Oct-2015

Keywords

  • 5-ALA
  • 5-aminolevulinic acid
  • Intracranial meningioma
  • Intraoperative fluorescence
  • Fluorescence-guided surgery
  • Fluorescence-guided resection
  • PROTOPORPHYRIN IX FLUORESCENCE
  • ALA-INDUCED PPIX
  • 5-AMINOLEVULINIC ACID
  • CONFOCAL MICROSCOPY
  • HIGH-RISK
  • SURGERY
  • TUMORS
  • NEURONAVIGATION
  • CANCER
  • BRAIN

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