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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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5-ALA fluorescence guided tumor resection of intraspinal extramedullar metastasized cerebral glioblastoma – a case report

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  • M. Klingenhöfer - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • M. Rapp - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • J. Perrin - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • M. Sabel - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP04-12

doi: 10.3205/09dgnc292, urn:nbn:de:0183-09dgnc2923

Published: May 20, 2009

© 2009 Klingenhöfer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Extracranial metastases of malignant glioma are an extremely rare event. Here we report on a 70-year-old male patient with multiple metastases of a glioblastoma in the spinal canal. Additionally, the patient had been in palliative treatment for prostate carcinoma since 2004. 8years ago he also suffered from a B cell Non-Hodgkin lymphoma of the thyroid gland.

Methods: Walking disturbance hospitalized the patient in July 2008. A cerebral MRI displayed multiple contrast enhancements, especially in the left periventricular white matter. Multiple enhancements were also detected along the spinal cord. Stereotactically guided serial biopsy of the cerebral enhancement assured the diagnosis of a glioblastoma multiforme (WHO IV°). Initially the patient rejected adjuvant therapy. Progressive paraplegia due to further growth of the aforementioned spinal masses and a lack of clear histopathology led to operative treatment. A 5-ALA fluorescence guided partial tumor resection at the level of the thoracic vertebral bodies 3 and 4 was performed via hemilaminectomy.

Results: After opening the dura a positive 5-ALA fluorescence signal of the perimedullary tumor was traceable. After surgery the patient had no change of his clinical condition. Histopathology affirmed the diagnosis of a spinal metastasis of a glioblastoma multiforme (WHO IV). Adjuvant therapy was declined by the patient. He died in October 2008.

Conclusions: Although malignant gliomas are characterized by diffuse infiltrative growth into the adjacent brain tissue, extraneural metastases from malignant gliomas are surprisingly rare. Immune status of the patient seems to be a decisive factor in the diagnosis and therapy of cancer. 5-ALA fluorescence guidance seems to be a promising supportive tool for the surgical treatment of intracerebral metastasized gliomas.