Fluorescence-Guided Resection With 5-Aminolevulinic Acid of Subependymomas of the Fourth Ventricle: Report of 2 Cases: Technical Case Report

被引:13
作者
Bernal Garcia, Luis Miguel [1 ]
Cabezudo Artero, Jose Manuel [1 ]
Marcelo Zamorano, Maria Bella [2 ]
Gilete Tejero, Ignacio [1 ]
机构
[1] Univ Hosp Infanta Cristina, Dept Neurosurg, Badajoz 06008, Spain
[2] Univ Hosp Infanta Cristina, Dept Intens Care, Badajoz 06008, Spain
关键词
5-Aminolevulinic acid; Fluorescence-guided resection; Fourth ventricle tumor; Intraoperative fluorescence; Subependymoma; PROTOPORPHYRIN IX FLUORESCENCE; PHOTODYNAMIC DIAGNOSIS; SPINAL EPENDYMOMA; BRAIN-TUMORS; MANAGEMENT; SURGERY;
D O I
10.1227/NEU.0000000000000682
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND AND IMPORTANCE: The usefulness of 5-aminolevulinic acid (5-ALA) for resection of malignant astrocytomas has been established in recent years. In addition to these tumors, it has been reported that 5-ALA fluorescence could be elicited in other tumors such as intracranial and spinal meningiomas or posterior fossa and spinal cord ependymomas, resulting in improved resections. Here, we present 2 cases of subependymomas of the fourth ventricle that showed intense fluorescence after 5-ALA administration. To the best of our knowledge, these are the first reported cases of subependymomas in this location in which 5-ALA elicited useful fluorescence. CLINICAL PRESENTATION: Case 1 was a 61-year-old woman with a history of headaches accompanied by vomiting in the last month. Magnetic resonance imaging (MRI) revealed a tumor occupying the fourth ventricle with slight irregular enhancement. She was operated on after administration of 5-ALA. The tumor emitted intense red fluorescence when illuminated with blue light. An MRI performed 48 hours after surgery confirmed complete resection of the tumor. The pathological diagnosis was subependymoma. Case 2 was a 35-year-old man with a history of several months of headaches and vomiting. An MRI revealed a tumor occupying the caudal part of the fourth ventricle with moderate and irregular enhancement. He was operated on after administration of 5-ALA. The tumor showed intense fluorescence. An MRI performed 48 hours after surgery confirmed a complete resection of the tumor. The pathological diagnosis was subependymoma. CONCLUSION: Fluorescence-guided resection with 5-ALA may be useful for resection of subependymomas of the fourth ventricle. However, further studies are needed.
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页码:E364 / E371
页数:8
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