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. 2019 Feb;13(1):119-125.
doi: 10.31616/asj.2018.0165. Epub 2018 Oct 24.

Fluorescence Guided Surgery with 5-Aminolevulinic Acid for Resection of Spinal Cord Ependymomas

Rafael García Moreno  1 , Luis Miguel Bernal García  1 , Hyaissa Ippolito Bastidas  1 , Carlos Andrés Mondragón Tirado  1 , Aurora Moreno Flores  1 , Juan Pablo Sosa Cabezas  1 , José Manuel Cabezudo Artero  1
Affiliations

Fluorescence Guided Surgery with 5-Aminolevulinic Acid for Resection of Spinal Cord Ependymomas

Rafael García Moreno et al. Asian Spine J. 2019 Feb.

Abstract

Study design: A retrospective study.

Purpose: We report our experience with 5-aminolevulinic acid (5-ALA)-assisted resection of spinal cord ependymomas in adults.

Overview of literature: Ependymoma is the most frequent primary spinal cord tumor in adults. Surgery is the treatment of choice in most cases. However, while complete resection is achieved in approximately 80% of cases, clinical improvement is achieved in 15% only. Five-ALA fluorescence-guided surgery seems to be useful for this tumor type.

Methods: We studied 14 patients undergoing 5-ALA fluorescence-guided surgery for spinal cord ependymomas in our service. The modified McCormick classification was used to determine clinical status and the degree of resection was assessed with magnetic resonance imaging.

Results: Of the 14 patients, the tumor showed an intense emission of fluorescence in 12 and the fluorescence was weak and nonuniform in two. Complete resection was achieved in 11 cases. According to the McCormick classification, 10 patients improved, two remained the same, and two deteriorated.

Conclusions: Our results confirm that 5-ALA fluorescence-guided resection is useful in spinal cord ependymoma resection. Although the rate of complete resections is similar to that in published series without 5-ALA, clinical results are better when using 5-ALA with a lower percentage of clinical deterioration.

Keywords: Aminolevulinic acid; Ependymoma; Fluorescence guided surgery; Spinal cord.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Case 4. (A) Intraoperative image with blue light showing the intense fluorescence emitted by the lesion. (B) Intraoperative image with white light in which the tumor bed is seen. (C) Intraoperative image with blue light in which no fluorescence emission is seen in the tumor bed. (D) Sagittal dorsal postoperative magnetic resonance imaging shows complete resection.
Fig. 2.
Fig. 2.
Case 7. (A) Sagittal cervicodorsal magnetic resonance imaging with gadolinium shows the lesion. (B) Intraoperative image with white light shows the spinal cord with numerous pathologic vessels on its surface. (C) Intraoperative image with blue light shows fluorescence emission before myelotomy.
See this image and copyright information in PMC

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