Photodynamic diagnosis in surgery for spinal ependymoma

Case illustration

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Protoporphyrin IX (PPIX), a metabolic product of 5-aminolevulinic acid (5-ALA) accumulating specifically in tumor tissue, shows fluorescence on exposure to excitation light having a peak wavelength of 405 ± 1 nm (laser spectrum overlaps that of ultraviolet light), and thus it allows detection of small amounts of tumor.1–3 We applied this fluorescence chemonavigation technique, which has been used in cerebral glioma surgery,2,3 to a case of spinal ependymoma.

This 19-year-old man presented with nuchal pain. Magnetic resonance imaging revealed a homogeneously enhancing intramedullary C4–5 spinal tumor (not shown); the tumor was then removed. One

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Address reprint requests to: Satoru Shimizu, M.D., Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, 228-8555 Japan. email:

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    Intraoperative photographs and graph. A: The tumor is exposed through the posterior median sulcus. B: The excitation light, having a peak wavelength of 405 ± 1 nm, is directed at the tumor after darkening the microscope light. A vivid reddish fluorescence is observed (arrow). C: On routine inspection of the resection bed, no residual tumor is visible. The circle denotes residual tumor that was revealed on the laser examination. D: Graph of the laser spectrum of the resection bed demonstrating the same emission peaks as the first examination at 635 and 704 nm, albeit with decreased fluorescence intensity (arrows).



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