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Updated: May 15, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
The impact of fluorescence guidance on spinal intradural tumour surgery
Sven O Eicker1, Frank W Floeth, Marcel Kamp
1Department of Neurosurgery, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany. eicker.s@mac.com
Purpose:
5-Aminolevulinic acid (5-ALA)-based fluorescence-guided surgery was shown to be beneficial for cerebral malignant gliomas. Extension of this technique for resection of meningiomas and cerebral metastasis has been recently evaluated. Aim of the present study is to evaluate the impact of fluorescence-guided surgery in spinal tumor surgery.
Methods:
Twenty-six patients with intradural spinal tumors were included in the study. 5-ALA was administered orally prior to the induction of anesthesia. Intraoperative, 440 nm fluorescence was applied after exploration of the tumor and, if positive, periodically during and at the end of resection to detect tumor-infiltrated sites.
Results:
Tumors of WHO grade III and IV were found in five patients. In detail intra- or perimedullary metastasis of malignant cerebral gliomas was found including glioblastoma WHO grade IV (n = 2), anaplastic astrocytoma WHO grade III (n = 1), anaplastic oligoastrocytoma WHO grade III (n = 1). In addition, one patient suffered from a spinal drop metastasis of a cerebellar medulloblastoma WHO grade IV. Tumors of WHO grade I were diagnosed in 18 patients: Eight cases of meningioma (two recurrences), six cases of neurinoma, one neurofibroma, two ependymoma and one plexus papilloma. At least, benign pathologies were histologically proven in three patients. All four spinal metastasis of malignant glioma (100 %), seven of eight meningiomas (87.5 %) and one of two ependymoma (50 %) were found to be ALA-positive.
Conclusion:
The present study demonstrates that spinal intramedullary gliomas and the majority of spinal intradural meningiomas are 5-ALA positive. As a surgical consequence, especially in intramedullary gliomas, the use of 5-ALA fluorescence seems to be beneficial.
Insights
5-Aminolevulinic acid (5-ALA) fluorescence aids spinal tumor surgery. This technique highlights spinal intramedullary gliomas and most meningiomas, improving surgical guidance for these challenging tumors.
Area of Science:
- Neurosurgery
- Oncology
- Medical Imaging
Background:
- 5-Aminolevulinic acid (5-ALA) fluorescence-guided surgery is established for cerebral gliomas.
- Its application for spinal tumors, including meningiomas and metastases, requires evaluation.
Purpose of the Study:
- To assess the efficacy of 5-ALA fluorescence-guided surgery in the resection of intradural spinal tumors.
Main Methods:
- Twenty-six patients with intradural spinal tumors received oral 5-ALA.
- Intraoperative fluorescence imaging (440 nm) was used to detect tumor infiltration during resection.
Main Results:
- 5-ALA positivity was observed in 100% of spinal malignant glioma metastases, 87.5% of meningiomas, and 50% of ependymomas.
- High-grade gliomas (WHO III-IV) and various benign tumors were analyzed.
Conclusions:
- Spinal intramedullary gliomas and most spinal intradural meningiomas exhibit 5-ALA fluorescence.
- 5-ALA fluorescence guidance appears beneficial, particularly for intramedullary spinal gliomas.
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