5-aminolevulinic Acid and Surgical Margin Analysis in Calvarial Metastasis with Pericranium or Dural Extension: Technical Note
Arq. bras. neurocir; 39 (3), 2020
Publication year: 2020
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 surgicalmargins 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.