Abstract
Meningiomas represent 30% of all intracranial neoplasms. They are predominantly slow growing extra axial brain tumours arising from arachnoidal cells and usually have an excellent prognosis if completely removed. However, radical tumour removal near vital functional structures and areas of infiltration is not always possible and histologically “benign” meningiomas may exhibit aggressive behaviour like infiltration and early recurrence. Biological markers that would make areas of infiltration visible by fluorescence might therefore have a significant impact on patient survival and quality of life.
5-Aminolevulinic acid (5-ALA) is a precursor in the cellular heme biosynthesis. The application of exogenous 5-ALA leads to an intracellular accumulation of protoporphyrin IX (PpIX), causing these PpIX saturated cells to become fluorescent and photosensitive under light of an appropriate wavelength. 5-ALA induced PpIX fluorescence has the ability to define infiltration zones into dural structures and bone and mark residual meningioma tissue. It has the potential to facilitate meningioma resection and to individualize the extent of dural resection for each patient in order to prevent morbidity.
Specific intracellular accumulation of PpIX can be used for photodynamic therapy (PDT). Induction of selective apoptosis, reduction of tumour vessel density and no risk of secondary carcinogenesis make PDT an ideal treatment option for meningiomas. Due to the variable potentials for PpIX accumulation within different meningioma subtypes, further research is required to ensure sufficiently intense fluorescence to enable PDT in these cases.
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Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E, Baio SM, Arico D, Sansovini M, Paganelli G (2009) Peptide receptor radionuclide therapy with (90)Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging 25:1407–1416
Bekelis K, Valdés PA, Erkmen K, Leblond F, Kim A, Wilson BC, Harris BT, Paulsen KD, Roberts DW (2011) Quantitative and qualitative 5-aminolevulinic acid-induced protoporphyrin IX fluorescence in skull base meningiomas. Neurosurg Focus 30(5):E8
Diamond I, Granelli SG, McDonagh AF, Nielsen S, Wilson CB, Jaenicke R (1972) Photodynamic therapy of malignant tumours. Lancet 2(7788):1175–1177
Dougherty TJ (1993) Photodynamic therapy. Photochem Photobiol 58(6):895–900
Fisher AM, Murphree AL, Gomer CJ (1995) 1995 clinical and preclinical photodynamic therapy. Lasers Surg Med 17(1):2–31
Gabeau-Lacet D, Aghi M, Betensky RA, Barker FG, Loeffler JS, Louis DN (2009) Bone involvement predicts poor outcome in atypical meningioma. J Neurosurg 111(3):464–471
Hashemi M, Schick U, Hassler W, Hefti M (2010) Tentorial meningiomas with special aspect to the tentorial fold: management, surgical technique, and outcome. Acta Neurochir 152(5):827–834
Hefti M (2011) Comment concerning: intraoperative 5-aminolevulinic-acid-induced fluorescence in meningiomas, Acta Neurochir DOl 1O.1007/s00701-010-0708-4, Intratumoral heterogeneity and fluorescence intensity in meningioma after 5-ALA pretreatment. Acta Neurochir 153(4):959–960
Hefti M, von Campe G, Signer A, Looser H, Landolt H (2008) 5-aminolevulinic acid induced protoporphyrin IX fluorescence in high-grade glioma surgery: a one-year experience at a single institution. Swiss Med Wkly 138(11–12):180–185
Hefti M, Holenstein F, Albert I, Looser H, Luginbühl V (2011) Susceptibility to 5-aminolevulinic acid based photodynamic therapy in WHO I meningioma cells corresponds to ferrochelatase activity. Photochem Photobiol 87(1):235–241
Kajimoto Y, Kuroiwa T, Miyatake S, Ichioka T, Miyashita M, Tanaka H, Tsuji M (2007) Use of 5-aminolevulinic acid in fluorescence-guided resection of meningioma with high risk of recurrence. Case report. J Neurosurg 10:1070–1074
Kallio M, Sankila R, Hakulinen T, Jäskelinen J (1992) Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery 31(1):2–12
Kawahara Y, Niiro M, Yokoyama S, Kuratsu J (2001) Dural congestion accompanying meningioma invasion into vessels: the dural tail sign. Neuroradiology 43(6):462–465
Kennedy JC, Pottier RH (1992) Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy. J Photochem Photobiol B 14:275–292
Kostron H, Fritsch E, Grunert V (1988) Photodynamic therapy of malignant brain tumours: a phase I/II trial. Br J Neurosurg 2(2):241–248
Kostron H et al (2010) Photodynamic diagnosis and therapy and the brain. In: Charles J (ed) Photodynamic therapy: methods and protocols. Humana Press Springer, New York
Lilge L, Wilson BC (1998) Photodynamic therapy of intracranial tissues: a preclinical comparative study of four different photosensitizers. J Clin Laser Med Surg 16:81–92
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109
Madsen SJ, Sun CH, Tromberg BJ, Yeh AT, Sanchez J, Hirschberg H (2002) Effects of combined photodynamic therapy and ionizing radiation on human glioma spheroids. Photochem Photobiol 76(4):411–416
Malham GM, Thomsen RJ, Finlay GJ, Baguley BC (1996) Subcellular distribution and photocytotoxicity of aluminium phthalocyanines and haematoporphyrin derivative in cultured human meningioma cells. Br J Neurosurg 10(1):51–57
Marks PV, Furneaux C, Shivvakumar R (1992) An in vitro study of the effect of photodynamic therapy on human meningiomas. Br J Neurosurg 6(4):327–332
Morofuji Y, Matsuo T, Hayashi Y, Suyama K, Nagata I (2008) Usefulness of intraoperative photodynamic diagnosis using 5-aminolevulinic acid for meningiomas with cranial invasion: technical case report. Neurosurgery 62(3 Suppl 1):102–104
Pfisterer WK, Coons SW, Aboul-Enein F, Hendricks WP, Scheck AC, Preul MC (2007) Implicating chromosomal aberrations with meningioma growth and recurrence: results from FISH and MIB-I analysis of grades I and II meningioma tissue. J Neurooncol 87(1):43–50
Philippon J, Cornu P (1991) The recurrence of meningiomas. In: Al-Mefty O (ed) Meningiomas. Raven, New York, pp 87–106
Pieper DR, Al-Mefty O, Hanada Y, Buechner D (1999) Hyperostosis associated with meningioma of the cranial base: secondary changes or tumor invasion. Neurosurgery 44(4):742–746; discussion 746–7
Sayaguès JM, Tabernero MD, MaÌllo A, Espinosa A, Rasillo A, Diaz P, Ciudad J, Lupez A, Merino M, Gonalves JM, Santos-Briz A, Morales F, Orfao A (2004) Intratumoral patterns of clonal evolution in meningiomas as defined by multicolor interphase fluorescence in situ hybridization (FISH): is there a relationship between histopathologically benign and atypical/anaplastic lesions? J Mol Diagn 6(4):316–325
Scheck AC, Shapiro JR, Coons SW, Norman SA, Johnson PC (1996) Biological and molecular analysis of a low grade recurrence of a glioblastoma multiforme. Clin Cancer Res 2:187–199
Schmidt MH, Meyer GA, Reichert KW, Cheng J, Krouwer HG, Ozker K, Whelan HT (2004) Evaluation of photodynamic therapy near functional brain tissue in patients with recurrent brain tumors. J Neurooncol 67(1–2):201–207
Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20(1):22–39
Stylli SS, Kaye AH (2006) Photodynamic therapy of cerebral glioma – a review. Part II: Clinical studies. J Clin Neurosci 13(7):709–717. Review
Tsai JC, Hsiao YY, Teng LJ, Chen CT, Kao MC (1999) Comparative study on the ALA photodynamic effects of human glioma and meningioma cells. Lasers Surg Med 24(4):296–305
Whitson WJ, Valdes PA, Harris BT, Paulsen KD, Roberts DW (2011) Confocal microscopy for the histologic fluorescence pattern of a recurrent atypical meningioma. Neurosurgery 68(6):E1768–E1773
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Hefti, M., von Campe, G. (2015). Fluorescence Guided Resection and Photodynamic Therapy in Meningiomas. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 14. Tumors of the Central Nervous System, vol 14. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7224-2_4
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DOI: https://doi.org/10.1007/978-94-017-7224-2_4
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