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

Article Information

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: Satoru4756@aol.com.

© AANS, except where prohibited by US copyright law.

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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).

References

1

Loh CSVernon DIMacRobert AJBedwell JBown SGBrown SB: Endogenous porphyrin distribution induced by 5-aminolaevulinic acid in the tissue layers of the gastrointestinal tract. J Photochem Photobiol B 20:47541993

2

Stummer WNovotny AStepp HGoetz CBise KReulen HJ: Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients. J Neurosurg 93:100310132000

3

Stummer WStepp HMöller GEhrhardt ALeonhard MReulen HJ: Technical principles for protoporphyrin-IX-fluorescence guided microsurgical resection of malignant glioma tissue. Acta Neurochir (Wien) 140:99510001998

4

Utsuki SOka HSato SSuzuki SShimizu STanaka S: Possibility of using laser spectroscopy for the intraoperative detection of nonfluorescing brain tumors and the boundaries of brain tumor infiltrates. Technical note. J Neurosurg 104:6186202006

5

Utsuki SOka HTanaka SIwamoto KFujii K: [Intraoperative photodynamic diagnosis of brain tumor using a purple semiconductor laser device for a PDD study.]. Jpn J Neurosurg 12:6476492003. (Jpn)

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