Predictive value of intraoperative 5-aminolevulinic acid-induced fluorescence for detecting bone invasion in meningioma surgery.

Abstract

OBJECT:

Bone invasion is a major concern in meningioma surgery, since it is predictive of the recurrence of cranial involvement, morbidity, and mortality. Bone invasion has been reported in 20%-68% of studies with histopathologically confirmed data. Unfortunately, radical resection of bone invasion remains challenging. The aim of this study was to assess the role of 5-aminolevulinic acid (5-ALA) fluorescence in guiding the resection of bone-invading meningiomas. To this purpose, the sensitivity, specificity, and positive and negative predictive values of 5-ALA in detecting meningioma bone invasion were evaluated.

METHODS:

Data from 12 patients affected by bone-invading meningiomas (7 with skull base and 5 with convexity meningiomas) who had undergone surgery with the assistance of 5-ALA fluorescence and neuronavigation between July 2012 and March 2013 at the Department of Neurosurgery of Padua were retrospectively analyzed. To evaluate the sensitivity and specificity of 5-ALA fluorescence in detecting meningioma tissue, a pathologist analyzed 98 surgical bone samples under blue light, according to different fluorescence patterns. Magnetic resonance images and CT scans were obtained pre- and postoperatively to determine the extent of bone invasion resection.

RESULTS:

The rate of 5-ALA-induced fluorescence of both tumor and bone invasion was 100%. Based on the pathological examination of bone specimens, 5-ALA presented a sensitivity of 89.06% (95% CI 81.41%-96.71%) and a specificity of 100% in detecting meningioma bone invasion, while the positive and negative predictive values were 100% and 82.93% (95% CI 71.41%-94.45%), respectively. At the postoperative stage, MRI did not detect cases of meningioma bone invasion, whereas CT scans revealed residual hyperostosis in 2 cases.

CONCLUSIONS:

In summary, 5-ALA fluorescence represents a suitable and reliable technique for identifying and removing bone infiltration by meningiomas. However, further studies are needed to prove the clinical consequences of this promising technique in a larger population.

• Authors: Alessandro Della Puppa, Oriela Rustemi, Giorgio Gioffrè, Irene Troncon, Giuseppe Lombardi, Giuseppe Rolma, Massimo Sergi, Marina Munari, Diego Cecchin, Marina Paola Gardiman, Renato Scienza
• Journal: Journal of neurosurgery (J Neurosurg) Vol. 120 Issue 4 Pg. 840-5 (Apr 2014) ISSN: 1933-0693 [Electronic] United States
• PMID: 24410157 (Publication Type: Journal Article)

Chemical References

• Aminolevulinic Acid

Topics

• Adult
• Aged
• Aged, 80 and over
• Aminolevulinic Acid
• Female
• Humans
• Male
• Meningeal Neoplasms (pathology, surgery)
• Meningioma (secondary, surgery)
• Middle Aged
• Sensitivity and Specificity
• Skull Base Neoplasms (diagnosis, secondary, surgery)