Abstract
Background Metabolic imaging technologies such as 5-aminolevulinic acid (ALA) fluorescence-guided
resection and positron-emission tomography (PET) imaging have improved glioma surgery
within the last decade. At present, these tools are not routinely used in meningioma
surgery.
Objective We present a case of a complex-shaped, recurrent skull base meningioma where 5-ALA
fluorescence-guidance and 18F-fluoroethyltyrosine (FET)-PET-imaging facilitated surgical resection.
Material and Methods The patient underwent surgery via a combined transcranial/transnasal endoscopic approach.
What was original is that both the microscope and the endoscope were equipped for
5-ALA fluorescence-guided surgery, respectively. Furthermore, preoperative FET-PET
imaging was fused with computed tomography (CT) and magnetic resonance imaging (MRI)
data for intraoperative navigation. The case richly illustrated the performance of
the different modalities.
Conclusions Metabolic imaging tools such as 5-ALA fluorescence-guided resection and navigated
FET-PET were helpful for the resection of this complex-shaped, recurrent skull base
meningioma. 5-ALA fluorescence was useful to dissect the adherent interface between
tumor and brain. Furthermore, it helped to delineate tumor margins in the nasal cavity.
FET-PET improved the assessment of bony and dural infiltration. We hypothesize that
these imaging technologies may reduce recurrence rates through better visualization
of tumor tissue that might be left unintentionally. This has to be verified in larger,
prospective trials.
Keywords
endoscopic - fluorescence-guided resection - FET-PET - recurrent meningioma - skull
base
