J Neurol Surg B Skull Base 2021; 82(S 02): S65-S270
DOI: 10.1055/s-0041-1725283
Presentation Abstracts
Live Session Abstracts

Limited Utility of 5-ALA Optical Fluorescence in Endoscopic Endonasal Skull Base Surgery: A Multicenter Retrospective Study

Alexander Micko
1   Keck School of Medicine, Medical University of Vienna, Vienna, Austria
,
Gabriel Zada
1   Keck School of Medicine, Medical University of Vienna, Vienna, Austria
,
Theodore Schwartz
2   Weill Cornell Medicine, New York City, New York, United States
› Author Affiliations
 

Objective: Incomplete resection of skull base pathology may result in local tumor recurrence. This study investigates the utility of 5-ALA fluorescence during endoscopic endonasal approaches (EEA) to increase visibility of pathologic tissue.

Methods: This retrospective multicenter series comprises patients with planned resection of an anterior skull base lesion who received preoperative 5-ALA at two tertiary care centers. Diagnostic use of a blue light endoscope was performed during EEA for all cases. Demographic and tumor characteristics as well as fluorescence status, quality and homogeneity were assessed for each skull base pathology.

Results: A total of 28 skull base pathologies underwent blue light EEA with preoperative 5-ALA including 15 pituitary adenomas (54%), 4 meningiomas (14%), 3 craniopharyngiomas (11%), 2 Rathke's Cleft Cysts (7%), as well as plasmacytoma, esthesioneuroblastoma and sinonasal squamous cell carcinoma. Of these, six (21%), showed invasive growth into surrounding structures such as dura, bone or compartments of the cavernous sinus. Tumor fluorescence was detected in two cases (7%), with strong fluorescence in one tuberculum sellae meningioma and vague fluorescence in one pituicytoma. In all other cases fluorescence was absent. Faint fluorescence of the normal pituitary gland was seen in one of 15 cases (7%). A comparison between the particular tumor entities as well as a correlation between invasiveness, WHO Grade, Ki-67 and positive fluorescence did not show any significant association.

Conclusion: With the possible exception of meningiomas, 5-ALA fluorescence has limited utility in the majority of endonasal skull base surgeries, although other pathology may be worth investigating.



Publication History

Article published online:
12 February 2021

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