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Neurological Surgery No Shinkei Geka Volume 34, Issue 8 （August 2006）

Neurological Surgery 脳神経外科 34巻8号（2006年8月発行）

Japanese English

テクニカル・ノート

Intraoperative photodynamic diagnosis for spinal ependymoma using 5-aminolevulinic acid Intraoperative Photodynamic Diagnosis for Spinal Ependymoma Using 5-aminolevulinic Acid：Technical Note 荒井隆雄 ¹ , 谷諭 ¹ , 磯島晃 ¹ , 長島弘泰 ¹ , 常喜達裕 ¹ , 藤ヶ崎純子 ² , 阿部俊昭 ¹ Takao ARAI ¹ , Satoshi TANI ¹ , Akira ISOSHIMA ¹ , Hiroyasu NAGASHIMA ¹ , Tatsuhiro JOKI ¹ , Junko TAKAHASHI-FUJIGASAKI ² , Toshiaki ABE ¹ ¹東京慈恵会医科大学脳神経外科 ²東京慈恵会医科大学神経病理 ¹Department of Neurosurgery,Jikei University School of Medicine ²Division of Neuropathology,Jikei University School of Medicine キーワード： ependymoma , 5-aminolevulinic acid , fluorescence-guided resection , photodynamic diagnosis , spinal tumor Keyword: ependymoma , 5-aminolevulinic acid , fluorescence-guided resection , photodynamic diagnosis , spinal tumor pp.811-817

発行日 2006年8月1日 Published Date 2006/8/1

DOI https://doi.org/10.11477/mf.1436100267

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　悪性脳腫瘍手術に対するphotodynamic diagnosis（PDD）は，近年急速に普及し重要な術中支援装置の1つとしてその地位を確立した．一方，脊髄腫瘍に対するPDDについてはいまだ報告されていない．今回われわれは，脊髄上衣腫におけるPDDの有用性を術中所見および病理組織学的所見をもとに検討した．

　Objective　The fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is a well established method for the treatment of brain tumor,especially malignant glioma. However,there is no report on photodynamic diagnosis (PDD) for spinal tumor. In the present study,we evaluated the usefulness of PDD for spinal ependymoma using 5-ALA.

　Methods　Three patients with spinal ependymoma received oral doses of 5-ALA (20 mg/kg body weight) 2 hours before anesthesia induction. Intraoperatively,fluorescence was observed with a 420 nm sharp cut filter after excitation with a violet semiconductor laser (405 nm) and was verified by analysis of fluorescent spectra. Residual fluorescent samples taken from the tumor cavity were examined histologically

　Results　Fluorescence peaked at 636nm in the removed tumors in all cases. Fluorescent tissue tended to exist at the cranial and caudal portion in the tumor cavity or around the anterior median fissure. The residual fluorescent tissue was not detected after removal of the tumor in case 1. The residual fluorescent tissue was composed of tumor cells and ependymal lining in case 2 or the infiltrated inflammatory cells and vascular endothelial cells in case 3. Postoperative magnetic resonance (MR) imaging showed no residual tumor in any of the cases.

　Conclusion　The results of this study indicate the usefulness of 5-ALA-induced tumor fluorescence in guiding resection of spinal ependymoma. 5-ALA-induced porphyrin fluorescence may label spinal ependymomas easily and clearly enough to enhance the completeness of tumor removal.