The Utility of 5-Aminolevulinic Acid for Microsurgical Resection of Meningiomas

Evelyn L. Turcotte, Rudy J. Rahme, Sarah A. Merrill, Ryan A. Hess, Salvatore C. Lettieri, Bernard R. Bendok

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Fluorescence-guided resection of brain tumors using 5-aminolevulinic acid (5-ALA) has been established for high-grade gliomas. Recently, its application for the resection of low grade tumors and benign lesions including meningioma has been suggested in the literature.1 Achieving a Simpson grade I resection in meningioma surgery is associated with a lower rate of recurrence.2,3 Although meningiomas are mostly benign and well-circumscribed lesions, they can be locally aggressive, invading brain parenchyma and other critical structures. In these cases, 5-ALA–guided resection may help maximize the extent of tumor resection and limit disruption of normal structures. In this video, we present 3 cases demonstrating the use of 5-ALA–induced fluorescence to alleviate 3 specific challenges in meningioma resection: 1) to aid visualization with a minimally invasive approach, 2) to distinguish recurrent tumor from scar tissue from prior treatments, and 3) to ensure that no viable tumor cells remain on the surface of a critical artery. The first patient is a 60-year-old woman who was found to have an incidental left sphenoid wing meningioma on magnetic resonance imaging. We elected for an extended lateral orbital craniotomy through a transpalpebral approach. The second patient is a 72-year-old man with recurrent left occipital parietal meningioma who underwent a parietal craniotomy. The third case was a 62-year-old woman with a foramen magnum meningioma encircling the left vertebral artery. These cases demonstrate the utility of 5-ALA in a variety of challenges associated with resection of meningiomas (Video 1).

Original languageEnglish (US)
Pages (from-to)343
Number of pages1
JournalWorld neurosurgery
Volume139
DOIs
StatePublished - Jul 2020

Keywords

  • 5-Aminolevulinic acid
  • Extended lateral orbital
  • Fluorescence
  • Meningioma
  • Skull base

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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