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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020; 39(03): 207-212
DOI: 10.1055/s-0040-1710312
Technical Note | Nota Técnica

5-aminolevulinic Acid and Surgical Margin Analysis in Calvarial Metastasis with Pericranium or Dural Extension: Technical Note

Ácido 5-aminolevulínico e análise da margem cirúrgica nas metástases da calvária com extensão de pericrânio ou dural: Nota Técnica
Erasmo Barros da Silva Junior 
1   Departament of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Joseph Franklin Chenisz da Silva 
1   Departament of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Maurício Coelho Neto
1   Departament of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Marcella Santos Cavalcanti
2   Departament of Neuropathology, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
,
Ricardo Ramina 
1   Departament of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
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Abstract

Metastasis to the calvarium with direct pericranium or dural infiltration may be treated with radical surgical removal in selected cases. We describe microsurgical resection of calvarial metastases with fluorescence-guided technique using 5-aminolevulinic acid (5-ALA) in two female patients with breast cancer. Fluorescence findings were positive in both cases. Margins in the scalp and dural layer were 5-ALA negative at the end of surgical removal. Intraoperative pathology was performed in all cases to confirm if oncological limits were free of disease. One case was 5-ALA positive in the outer layer of the dura-mater and another in the pericranium. At the end of the removal in both cases, the surgical margins were 5-ALA fluorescence-free. Intraoperative pathology confirmed oncological limits of the resection. 5-aminolevulinic acid fluorescence-guided surgery for calvarial metastases with pericranium and/or dural extension seems to be a safe and reliable method to aid the surgical margins for complete removal, possibly delaying or avoiding adjuvant irradiation for progression control.

Resumo

Metástases da calvária com infiltração dural ou do pericrânio podem ser tratadas com remoção cirúrgica radical em casos selecionados. Descrevemos a ressecção microcirúrgica de metástases da calvária guiada por fluorescência usando ácido 5-aminolevulínico (5-ALA) em duas pacientes do sexo feminino com câncer de mama. Os achados da fluorescência foram positivos em ambos os casos. As margens nas camadas do couro cabeludo e dural foram negativas para 5-ALA ao final da remoção cirurgica. Patologia intraoperatória foi realizada em ambos os casos para confirmar os limites oncológicos. Um caso foi positivo para 5-ALA na camada externa da dura-máter e outra no pericrânio. No final da remoção, nos dois casos, as margens cirúrgicas foram 5-ALA negativas. A patologia intraoperatória confirmou as margens cirúrgicas livres. Cirurgia guiada por fluorescência com ácido 5-ALA para metástases da calvária com extensão para pericrânio e / ou dural parece ser um método seguro e confiável para auxiliar as margens cirúrgicas na remoção completa, possivelmente evitando ou retardando a irradiação adjuvante no controle da progressão.

Keywords

5-aminolevulinic acid - calvarial metastases - fluorescence surgery - metastases - skull metastases - surgical margins

Palavras-chave

ácido 5-aminolevulinico - metástases da calvária - cirurgia por fluorescência - metástases - metástases cranianas - margens cirúrgicas

Ethical Approval and Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (CEP - Comitê de Ética em Pesquisa – Instituto de Neurologia de Curitiba) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from both individual participants included in the present study.




Publication History

Received: 03 January 2020

Accepted: 24 March 2020

Article published online:
23 June 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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