Neuro-endoscopic cylinder surgery and 5-aminolevulinic acid (5-ALA) photodynamic diagnosis of deep-seated intracranial lesions.

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Neuro-endoscopic cylinder surgery and 5-aminolevulinic acid (5-ALA) photodynamic diagnosis of deep-seated intracranial lesions.

World Neurosurg. 2018 Mar 23;:

Authors: Choo J, Takeuchi K, Nagata Y, Ohka F, Kishida Y, Watanabe T, Satoh Y, Nagatani T, Kato K, Wakabayashi T, Natsume A

Abstract
BACKGROUND: Microscopic detection of intracranial brain tumors with 5-aminolevulinic acid (5-ALA) has proven extremely useful, and reports the use of 5-ALA have recently increased. However, few reports have described 5-ALA photodynamic diagnosis (PDD) using a neuro-endoscope. We performed neuro-endoscopic 5-ALA PDD for various brain lesions and present a procedure using only a neuro-endoscope.
METHODS: We describe the diagnosis of 20 intracranial brain lesion cases with a 5-ALA-guided fluorescence endoscope. A light-emitting diode that emitted either white light (WL) or 400- to 410-nm violet light (VL) was attached to a neuro-endoscope. We performed cylinder surgery with a transparent sheath under observation with a rigid neuro-endoscope.
RESULTS: Neuro-endoscopic biopsies were performed in 11 patients, and resections were performed in 9 patients. All lesions were observed with a neuro-endoscope under sequential WL and VL. We confirmed the presence of a red fluorescent lesion under VL in 15 cases, including 4 of 5 glioblastoma cases (80%); 1 of 2 anaplastic astrocytoma cases (50%); 4 of 5 diffuse large B-cell lymphoma cases (80%); 2 of 2 metastatic brain tumors; 1 of 1 case each of diffuse astrocytoma, pilocytic astrocytoma, inflammatory change, and germinoma (100%); and no cases of anaplastic ependymoma or cysticercosis. Pre-targeted lesions were accurately harvested from all biopsies. Gross total resection was achieved in 5 of 9 patients using a resection procedure.
CONCLUSIONS: Our described method offers a promising technique for achieving precise brain tumor biopsies and safe resection. 5-ALA PDD is useful for conducting neuro-endoscopic cylinder surgery for brain tumors.

PMID: 29581022 [PubMed - as supplied by publisher]

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