Fluorescence-guided resection with 5-aminolevulinic acid of meningeal sarcoma in a child.

Abstract

The usefulness of fluorescence-guided resection with 5-aminolevulinic acid for malignant brain gliomas was demonstrated by Stummer. However, there are several articles in the literature showing the usefulness of the technique for other types of tumors, including benign tumors, such as ependymomas or meningiomas. Meningeal sarcomas are rare, highly aggressive malignant tumors, predominately affecting the pediatric population and have a poor prognosis in spite of treatment. Surgical treatment thereof should consist of the most complete resection possible. In this article, we present the case of a seven-year-old boy who received surgical treatment for a left frontal tumor after oral administration of 5-aminolevulinic acid (5-ALA); the definitive histological diagnosis of which was meningeal sarcoma. The technique was useful for achieving a complete resection, as the lesion emitted intense fluorescence, and after resection of the lesion with the usual technique, intraoperative fluorescent spots were observed in the resection bed that were also tumor. Imaging tests performed 5years after surgery ruled out recurrence of the tumor. To our knowledge, this is the first case published in the literature of meningeal sarcoma in a child in which intraoperative fluorescence with 5-ALA was used to achieve a complete resection.