Abstract:
:OBJECTIVE Stereotactic needle biopsies are usually performed for histopathological confirmation of intracranial lymphomas to guide adequate treatment. During biopsy, intraoperative histopathology is an effective tool to avoid acquisition of nondiagnostic samples. In the last years, 5-aminolevulinic acid (5-ALA)-induced fluorescence has been increasingly used for visualization of diagnostic brain tumor tissue during stereotactic biopsies. Recently, visible fluorescence was reported in the first cases of intracranial lymphomas as well. The aim of this study is thus to investigate the technical and clinical utility of 5-ALA-induced fluorescence in a large series of stereotactic biopsies for intracranial lymphoma. METHODS This prospective study recruited adult patients who underwent frameless stereotactic needle biopsy for a radiologically suspected intracranial lymphoma after oral 5-ALA administration. During biopsy, samples from the tumor region were collected for histopathological analysis, and presence of fluorescence (strong, vague, or no fluorescence) was assessed with a modified neurosurgical microscope. In tumors with available biopsy samples from at least 2 different regions the intratumoral fluorescence homogeneity was additionally investigated. Furthermore, the influence of potential preoperative corticosteroid treatment or immunosuppression on fluorescence was analyzed. Histopathological tumor diagnosis was established and all collected biopsy samples were screened for diagnostic lymphoma tissue. RESULTS The final study cohort included 41 patients with intracranial lymphoma. Stereotactic biopsies with assistance of 5-ALA were technically feasible in all cases. Strong fluorescence was found as maximum level in 30 patients (75%), vague fluorescence in 2 patients (4%), and no visible fluorescence in 9 patients (21%). In 28 cases, samples were obtained from at least 2 different tumor regions; homogenous intratumoral fluorescence was found in 16 of those cases (57%) and inhomogeneous intratumoral fluorescence in 12 (43%). According to histopathological analysis, all samples with strong or vague fluorescence contained diagnostic lymphoma tissue, resulting in a positive predictive value of 100%. Analysis showed no influence of preoperative corticosteroids or immunosuppression on fluorescence. CONCLUSIONS The data obtained in this study demonstrate the technical and clinical utility of 5-ALA-induced fluorescence in stereotactic biopsies of intracranial lymphomas. Thus, 5-ALA can serve as a useful tool to select patients not requiring intraoperative histopathology, and its application should markedly reduce operation time and related costs in the future.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Kiesel B,Millesi M,Woehrer A,Furtner J,Bavand A,Roetzer T,Mischkulnig M,Wolfsberger S,Preusser M,Knosp E,Widhalm Gdoi
10.3171/2018.3.FOCUS1859subject
Has Abstractpub_date
2018-06-01 00:00:00pages
E7issue
6issn
1092-0684pii
2018.3.FOCUS1859journal_volume
44pub_type
杂志文章abstract::OBJECTIVE The objective of this study was to identify clinically relevant predictors of progression-free survival and functional outcomes in patients who underwent surgery for intramedullary spinal cord tumors (ISCTs). METHODS An institutional spinal tumor registry and billing records were reviewed to identify adult p...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2016.5.FOCUS16147
更新日期:2016-08-01 00:00:00
abstract::There is growing evidence to suggest that pregnancy may increase the risk of hemorrhage from cavernous malformations (CMs). In the present case, a 21-year-old primigravida was admitted to the authors' neurosurgical service after a cesarean section. Three weeks before admission she had experienced rapidly progressive b...
journal_title:Neurosurgical focus
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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journal_title:Neurosurgical focus
pub_type: 传,历史文章,杂志文章
doi:10.3171/2017.6.FOCUS17265
更新日期:2017-09-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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abstract::Intracranial electroencephalography monitoring of the insula is an important tool in the investigation of the insula in medically intractable epilepsy and has been shown to be safe and reliable. Several methods of placing electrodes for insular coverage have been reported and include open craniotomy as well as stereot...
journal_title:Neurosurgical focus
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pub_type: 杂志文章,评审
doi:
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abstract:OBJECT:The supraorbital eyebrow approach is a minimally invasive technique that offers wide access to the anterior skull base region and parasellar area through asubfrontal corridor. The use of neuroendoscopy allows one to extend the approach further to the pituitary fossa, the anterior third ventricle, the interpedunc...
journal_title:Neurosurgical focus
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doi:10.3171/2014.7.FOCUS14203
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journal_title:Neurosurgical focus
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doi:10.3171/2018.1.FocusVid.17572
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doi:10.3171/foc.2000.9.4.10
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journal_title:Neurosurgical focus
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doi:10.3171/2011.3.FOCUS117
更新日期:2011-05-01 00:00:00
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doi:10.3171/foc.1997.2.6.6
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doi:10.3171/2017.4.FOCUS1794
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pub_type: 杂志文章
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更新日期:2008-01-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1999.7.4.2
更新日期:1999-10-15 00:00:00
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journal_title:Neurosurgical focus
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pub_type: 杂志文章
doi:10.3171/2016.3.FOCUS1650
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journal_title:Neurosurgical focus
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doi:10.3171/foc.1997.3.2.5
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pub_type: 杂志文章,评审
doi:10.3171/2013.7.FOCUS1346
更新日期:2013-09-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2012.12.FOCUS12338
更新日期:2013-02-01 00:00:00
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doi:10.3171/2020.1.FOCUS19920
更新日期:2020-04-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2013.1.FOCUS12380
更新日期:2013-03-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.11.FOCUS14694
更新日期:2015-02-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:
更新日期:2006-04-15 00:00:00
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pub_type: 杂志文章
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更新日期:2012-03-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.3.FOCUS1528
更新日期:2015-06-01 00:00:00