Abstract
Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. In the present paper, we review the existing literature about the application of 5-ALA as an intraoperative tool for the resection of intracranial meningiomas. PubMed was used as the database for search tasks. We included articles published in English without limitations regarding publication date. Tumor fluorescence can occur in benign meningiomas (WHO grade I) as well as in WHO grade II and WHO grade III meningiomas. Most of the reviewed studies report fluorescence of the main tumor mass with high sensitivity and specificity. However, different parts of the same tumor can present with a different fluorescent pattern (heterogenic fluorescence). Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility. However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.
Highlights
Meningiomas are the second most common primary tumors affecting the central nervous system, accounting for more than 35 % of the primary brain tumors in adults [1]
We summarize the reports and clinical studies that have been published about the application of 5-aminolevulinic acid (5-ALA) in intracranial meningioma surgery, and we report two illustrative cases of our institutional experience, in order to define the status quo of this technique in current intracranial meningioma surgery
The literature search identified 11 publications, all in English, that reported of 5-ALA-assisted intracranial meningioma surgery
Summary
Meningiomas are the second most common primary tumors affecting the central nervous system, accounting for more than 35 % of the primary brain tumors in adults [1]. The vast majority of meningiomas are slow-growing, benign (noncancerous) tumors, certain subtypes are more aggressive than others, and benign does not mean that they are without risk. Depending on its size and location, a benign meningioma can cause significant problems to the patient, become life-threatening, and be extremely difficult to treat. Being diagnosed with an intracranial meningioma means a reduction of life-expectancy to the patient, which is largely caused by tumor recurrence or outgrowth of tumor remnants, Neurosurg Rev (2015) 38:619–628 irrespective of the WHO grade. Even tumors that are (reported to be) resected completely may recur, which makes the operative treatment of every intracranial meningioma a challenge for the surgeon
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