Brain Tumor Res Treat.  2019 Oct;7(2):105-111. 10.14791/btrt.2019.7.e39.

Experience Profiling of Fluorescence-Guided Surgery II: Non-Glioma Pathologies

• Ji SY
• Kim JW
• Park CK

• KMID: 2461183
• DOI: http://doi.org/10.14791/btrt.2019.7.e39

Abstract

BACKGROUND
Only sporadic reports of fluorescence-guided surgery (FGS) have been published for non-glioma conditions. In this study, we focus on epidemiological data of fluorescence patterns and report the diverse experiences of FGS in non-gliomas.
METHODS
During 8.5 years between July 2010 and January 2019, 900 FGS for brain tumor performed in Seoul National University Hospital. Among them, a total of 73 histologically proven non-glioma patients were analyzed. Indications for FGS have been the possibility of anaplastic tumor in intra-axial tumors in preoperative MRI and an attempt to reproduce known anecdotal experiences of 5-Aminolevulinic Acid (5-ALA) fluorescence.
RESULTS
In cases of brain tumors except for gliomas, the most frequent cases were brain metastasis (23 cases) followed by lymphomas (9 cases) and meningeal tumors (8 cases). And there were embryonal tumors (6 cases), hemangioblastomas (4 cases), and solitary fibrous tumor/hemangiopericytomas (3 cases). Most brain metastases, meningiomas, primary central nervous system lymphomas, and treatment effect cases showed positive fluorescence. Moreover, some non-tumorous conditions also showed positive fluorescence. However, hemangioblastoma and germ cell tumor did not observe any fluorescence at all.
CONCLUSION
5-ALA induced fluorescence is not limited to glioma but is also evident in non-glioma and non-neoplastic conditions. This 5-ALA-induced fluorescence may be used as an intraoperative tool for various brain conditions.

Keyword

Fluorescence; Surgery; Meningioma; Metastasis

MeSH Terms

Brain
Brain Neoplasms
Central Nervous System
Fluorescence
Glioma
Hemangioblastoma
Humans
Lymphoma
Magnetic Resonance Imaging
Meningeal Neoplasms
Meningioma
Neoplasm Metastasis
Neoplasms, Germ Cell and Embryonal
Pathology*
Seoul

Figure

• 

  Fig. 1 Distribution of histological diagnosis of 73 fluorescence-guided surgery cases excluding glioma. Experience of 827 glioma cases is described in the other paper in this issue (Experience profiling of fluorescence-guided surgery I: gliomas). Numbers in the diagram indicate number of cases. SFT/HPC, solitary fibrous tumor/hemangiopericytoma; Gr, grade.

• 

  Fig. 2 A: Distribution of fluorescence intensity of 23 brain metastasis from various primary cancer sites. A single cubic unit denotes individual case. B: Illustrative case of brain metastasis of malignant peripheral nerve sheath tumor (MPNST). Transaxial T2-weighted and coronal T1-weighted MR images show a well enhancing round-shpaed mass with internal hemorrhage and peritumoral edema in left temporal lobe. The mass was excised in en bloc fashion and the part of the internal side of the mass showed strong red fluorescence. RCC, renal cell carcinoma.

• 

  Fig. 3 Intraoperative photograph showing positive fluorescence and magnetic resonance images of 3 primary central nervous system angiitis cases.

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  Fig. 4 Magenetic resonance images and intraoperative fluorescence pattern of treatment effect after radiotherapy. Positive fluorescence areas were observed although no viable tumor cells were idendtified in histological examination.

• 

  Fig. 5 Examples of non-tumorous conditions showing positive fluorescenase. A: A case of intracranial heterotopic ossification. Non-contrast computed tomography shows dense calcific lesion in the left frontal lobe.The lesion is irregulary enhanced in MRI. Intraoperative finding shows strong fluorescence. Histologically, the mass is composed of calcification with numerous Rosenthal fibers. B: A case of glioependymal cyst. Preoperative MRI shows an enhanced mass lesion with cyst in the left periventricular white matter. The solid portion of resected mass exhibit strong fluorescence. Histological finding denies any evidence of neoplasm but for only showing reactive gliosis with ciliated ependymal linings. A, B: Hematoxylin and eosin stain; original magnification ×400. C: Cases of pachymeningitis (left) and meningoencephlitis (right) which shows positive fluorescence.

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