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5-ALA fluorescence-guided endoscopic surgery for mixed germ cell tumors

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Abstract

5-Aminolevulinic acid (5-ALA) fluorescence-guided surgery is widely used for detection and planning of resection of malignant gliomas and other brain tumors. However, no reports have described 5-ALA fluorescence-guided surgery or direct visualization of germ cell tumors. Here, we report two cases of germ cell tumors in which a positive 5-ALA fluorescent signal was visualized with a neuroendoscope. Both cases had a tumor in the pineal region that was associated with hydrocephalus. The patients underwent surgery after administration of 5-ALA. After ventricular puncture of the anterior horn, we could observe the ventricular wall and tumor using the Karl Storz Photodynamic diagnosis system endoscope. Then, biopsy of the pineal tumor and endoscopic third ventriculostomy were performed in both cases. In case 1, a 22-year-old man, part of the ventricular wall and tumor tissue showed red fluorescence. In case 2, a 16-year-old man, part of the fornix and infundibular recess showed red fluorescence, and the tumor showed relatively weak red fluorescence. The histopathological diagnosis of both cases was pure germinoma. This is the first report of direct visualization of mixed germinomas with 5-ALA fluorescence-guided endoscopic surgery. This method not only allows visualization of the tumor mass, but may also be useful for detailed observation in the ventricular wall.

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References

  1. Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, Group A-GS (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401. doi:10.1016/S1470-2045(06)70665-9

    Article  CAS  PubMed  Google Scholar 

  2. Neira JA, Ung TH, Sims JS, Malone HR, Chow DS, Samanamud JL, Zanazzi GJ, Guo X, Bowden SG, Zhao B, Sheth SA, McKhann GM, Sisti MB, Canoll P, D’Amico RS, Bruce JN (2016) Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance. J Neurosurg. doi:10.3171/2016.7.JNS16232

    PubMed  Google Scholar 

  3. Yamaguchi F, Takahashi H, Teramoto A (2007) Photodiagnosis for frameless stereotactic biopsy of brain tumor. Photodiagn Photodyn Ther 4:71–75. doi:10.1016/j.pdpdt.2006.09.005

    Article  Google Scholar 

  4. Ellenbogen RG, Moores LE (1997) Endoscopic management of a pineal and suprasellar germinoma with associated hydrocephalus: technical case report. Minim Invasive Neurosurg 40:13–15. doi:10.1055/s-2008-1053406. (discussion 16)

    Article  CAS  PubMed  Google Scholar 

  5. Kamp MA, Grosser P, Felsberg J, Slotty PJ, Steiger HJ, Reifenberger G, Sabel M (2012) 5-aminolevulinic acid (5-ALA)-induced fluorescence in intracerebral metastases: a retrospective study. Acta Neurochir 154:223–228. doi:10.1007/s00701-011-1200-5. (discussion 228)

    Article  PubMed  Google Scholar 

  6. Marbacher S, Klinger E, Schwyzer L, Fischer I, Nevzati E, Diepers M, Roelcke U, Fathi AR, Coluccia D, Fandino J (2014) Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases. Neurosurg Focus 36:E10. doi:10.3171/2013.12.FOCUS13464

    Article  PubMed  Google Scholar 

  7. Grossman R, Nossek E, Shimony N, Raz M, Ram Z (2014) Intraoperative 5-aminolevulinic acid-induced fluorescence in primary central nervous system lymphoma. J Neurosurg 120:67–69. doi:10.3171/2013.9.JNS131076

    Article  PubMed  Google Scholar 

  8. Yamamoto T, Ishikawa E, Miki S, Sakamoto N, Zaboronok A, Matsuda M, Akutsu H, Nakai K, Tsuruta W, Matsumura A (2015) Photodynamic diagnosis using 5-aminolevulinic acid in 41 biopsies for primary central nervous system lymphoma. Photochem Photobiol 91:1452–1457. doi:10.1111/php.12510

    Article  CAS  PubMed  Google Scholar 

  9. Bernal García LM, Cabezudo Artero JM, Marcelo Zamorano MB, Gilete Tejero I (2015) Fluorescence-guided resection with 5-aminolevulinic Acid of subependymomas of the fourth ventricle: report of 2 cases: technical case report. Neurosurgery 11(Suppl 2):E364–E371. doi:10.1227/NEU.0000000000000682. (discussion E371)

    Article  PubMed  Google Scholar 

  10. Eljamel MS, Leese G, Moseley H (2009) Intraoperative optical identification of pituitary adenomas. J Neurooncol 92:417–421. doi:10.1007/s11060-009-9820-9

    Article  PubMed  Google Scholar 

  11. 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 62:102–103. doi:10.1227/01.neu.0000317378.22820.46. (discussion 103–104)

    PubMed  Google Scholar 

  12. Millesi M, Kiesel B, Mischkulnig M, Martínez-Moreno M, Wöhrer A, Wolfsberger S, Knosp E, Widhalm G (2016) Analysis of the surgical benefits of 5-ALA-induced fluorescence in intracranial meningiomas: experience in 204 meningiomas. J Neurosurg. doi:10.3171/2015.12.JNS151513

    PubMed  Google Scholar 

  13. Barbagallo GM, Certo F, Heiss K, Albanese V (2014) 5-ALA fluorescence-assisted surgery in pediatric brain tumors: report of three cases and review of the literature. Br J Neurosurg 28:750–754. doi:10.3109/02688697.2014.913779

    Article  PubMed  Google Scholar 

  14. Tamura Y, Kuroiwa T, Kajimoto Y, Miki Y, Miyatake S, Tsuji M (2007) Endoscopic identification and biopsy sampling of an intraventricular malignant glioma using a 5-aminolevulinic acid-induced protoporphyrin IX fluorescence imaging system. Technical note. J Neurosurg 106:507–510. doi:10.3171/jns.2007.106.3.507

    Article  PubMed  Google Scholar 

  15. Ritz R, Feigl GC, Schuhmann MU, Ehrhardt A, Danz S, Noell S, Bornemann A, Tatagiba MS (2011) Use of 5-ALA fluorescence guided endoscopic biopsy of a deep-seated primary malignant brain tumor. J Neurosurg 114:1410–1413. doi:10.3171/2010.11.JNS10250

    Article  PubMed  Google Scholar 

  16. Rapp M, Kamp M, Steiger HJ, Sabel M (2014) Endoscopic-assisted visualization of 5-aminolevulinic acid-induced fluorescence in malignant glioma surgery: a technical note. World Neurosurg 82:e277–e279. doi:10.1016/j.wneu.2013.07.002

    Article  PubMed  Google Scholar 

  17. Longatti P, Basaldella L, Sammartino F, Boaro A, Fiorindi A (2013) Fluorescein-enhanced characterization of additional anatomical landmarks in cerebral ventricular endoscopy. Neurosurgery 72:855–860. doi:10.1227/NEU.0b013e3182889e27

    Article  PubMed  Google Scholar 

  18. Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumià J (1997) Neuroendoscopic management of pineal region tumours. Acta Neurochir 139:12–20 (discussion 20–11)

    Article  CAS  PubMed  Google Scholar 

  19. Oi S, Kamio M, Joki T, Abe T (2001) Neuroendoscopic anatomy and surgery in pineal region tumors: role of neuroendoscopic procedure in the ‘minimally-invasive preferential’ management. J Neurooncol 54:277–286

    Article  CAS  PubMed  Google Scholar 

  20. Reddy AT, Wellons JC, Allen JC, Fiveash JB, Abdullatif H, Braune KW, Grabb PA (2004) Refining the staging evaluation of pineal region germinoma using neuroendoscopy and the presence of preoperative diabetes insipidus. Neuro Oncol 6:127–133

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hayashi Y, Nakada M, Tanaka S, Uchiyama N, Kita D, Hamada J (2010) Implication of 5-aminolevulinic acid fluorescence of the ventricular wall for postoperative communicating hydrocephalus associated with cerebrospinal fluid dissemination in patients with glioblastoma multiforme: a report of 7 cases. J Neurosurg 112:1015–1019. doi:10.3171/2009.8.JNS09516

    Article  PubMed  Google Scholar 

  22. Moon JH, Kim SH, Shim JK, Roh TH, Sung KS, Lee JH, Park J, Choi J, Kim EH, Kang SG, Chang JH (2016) Histopathological implications of ventricle wall 5-aminolevulinic acid-induced fluorescence in the absence of tumor involvement on magnetic resonance images. Oncol Rep 36:837–844. doi:10.3892/or.2016.4881

    PubMed  Google Scholar 

  23. Mishima K, Nishikawa R (2008) Application of fluorescence diagnosis in brain tumor removal. J Saitama Med Sch 36:109–111 (Japanese)

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan

    Junichi Takeda, Masahiro Nonaka, Yi Li, Yumiko Komori, Takamasa Kamei, Ryoichi Iwata, Tetsuo Hashiba, Kunikazu Yoshimura & Akio Asai

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  1. Junichi Takeda
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  2. Masahiro Nonaka
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  3. Yi Li
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  4. Yumiko Komori
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  5. Takamasa Kamei
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  6. Ryoichi Iwata
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  7. Tetsuo Hashiba
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  8. Kunikazu Yoshimura
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  9. Akio Asai
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Correspondence to Masahiro Nonaka.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Takeda, J., Nonaka, M., Li, Y. et al. 5-ALA fluorescence-guided endoscopic surgery for mixed germ cell tumors. J Neurooncol 134, 119–124 (2017). https://doi.org/10.1007/s11060-017-2494-9

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  • DOI: https://doi.org/10.1007/s11060-017-2494-9

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