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5-ALA-Induced Fluorescence in Leptomeningeal Dissemination of Spinal Malignant Glioma.

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5-ALA-Induced Fluorescence in Leptomeningeal Dissemination of Spinal Malignant Glioma.

World Neurosurg. 2018 Feb;110:345-348

Authors: Krause Molle Z, Gierga Ok, Turowski B, Steiger HJ, Cornelius JF, Rapp M, Sabel M, Kamp MA

Summary
BACKGROUND: 5-Aminolevulinic acid (5-ALA)-fluorescence-guided resection of malignant glioma is properly established in lots of neuro-oncology departments. As well as, the usage of 5-ALA has been reported for cerebral metastases, meningioma, and spinal tumors. We report a case of a affected person with a leptomeningeal unfold of a Ok27M-mutated spinal anaplastic astrocytoma (World Well being Group° [WHO] III), which was detected by its faint 5-ALA-induced fluorescence.
CASE DESCRIPTION: A 26-year-old feminine affected person with an incomplete resection of a spinal astrocytoma (WHO II) at Th1-Th3 was handled with adjuvant mixed radiotherapy/chemotherapy. After four years the affected person suffered from a progressive paraplegia. Magnetic resonance imaging of the central nervous system confirmed no native development of the spinal astrocytoma however an in depth disseminated leptomeningeal tumor formation. The cerebrospinal fluid of the affected person obtained by lumbar puncture confirmed no indication of malignant cells within the cytopathologic examination. An open biopsy with preoperative administered 5-ALA with excision of the sensory nerve root from the cauda equina was carried out. The biopsy confirmed a clearly mild pink 5-ALA-induced fluorescence. The histopathologic examination confirmed a leptomeningeal unfold of a Ok27M-mutated anaplastic astrocytoma (WHO° III) with out R132H-IDH1 mutation.
CONCLUSIONS: Earlier utility of 5-ALA may intraoperatively assist to visualise and determine leptomeningeal unfold.

PMID: 29066318 [PubMed – indexed for MEDLINE]

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