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Vol. 28. Num. 5.September - October 2017Pages 211-258
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Vol. 28. Num. 5.September - October 2017Pages 211-258
Case Report
DOI: 10.1016/j.neucir.2017.03.002
Fluorescence guided resection with 5-aminolevulinic acid of a pilomyxoid astrocytoma of the third ventricle
Resección guiada por fluorescencia con ácido 5-aminolevulínico de un astrocitoma pilomixoide del tercer ventrículo
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Luis Miguel Bernal Garcíaa,
Corresponding author
lumi_bega@hotmail.com

Corresponding author.
, Jose Manuel Cabezudo Arteroa, Rafael García Morenoa, Maria Bella Marcelo Zamoranob, Carlos Mayoral Guisadoc
a Department of Neurosurgery, University Hospital Infanta Cristina, Badajoz, Spain
b Department of Intensive Care, University Hospital Infanta Cristina, Badajoz, Spain
c Department of Pathology, University Hospital Infanta Cristina, Badajoz, Spain
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Abstract

Fluorescence-guided resection with 5-aminolevulinic acid has been shown to be useful in the resection of certain brain tumors other than high grade gliomas, facilitating the intraoperative differentiation of neoplastic tissue. The technique enables the surgeon to ensure that no tumor fragments remain, thereby achieving higher rates of complete resection.

Tihan first described pilomyxoid astrocytomas in 1999. They are currently classified as grade II astrocytoma according to the WHO classification system and, because of their tendency to recur and their dissemination through the cerebrospinal fluid pathways, they are considered to be more aggressive than pilocytic astrocytoma. As a result, management of these tumors must be more aggressive, always aiming for complete macroscopic resection whenever possible.

In this article, we present a case of pilomyxoid astrocytoma of the third ventricle in which the use of fluorescence-guided resection with 5-ALA facilitated complete resection. Imaging tests performed after five years revealed no signs of recurrence and no adjuvant radiotherapy or chemotherapy was required. This article also comprises a review of the literature concerning the characteristics and management of this tumor, which was recently considered to be a different histopathological entity.

Keywords:
Fluorescence guided resection
5-Aminolevulinic acid
Intraoperative fluorescence
Pilomyxoid astrocytoma
Third ventricle tumor
Resumen

La resección guiada por fluorescencia con 5-ALA se ha mostrado útil en tumores diferentes a los gliomas de alto grado, permitiendo la diferenciación intraoperatoria del tejido tumoral. La técnica permite revisar el lecho quirúrgico para comprobar que no quedan fragmentos tumorales, consiguiéndose así mejorar las tasas de resección completa.

El astrocitoma pilomixoide, descrito en 1999 por Tihan, se clasifica actualmente como un astrocitoma grado ii en la clasificación de la OMS y es considerado como una variante con mayor agresividad que el astrocitoma pilocítico por su tendencia a la recidiva y a la diseminación por el líquido cefalorraquídeo. Por ello el tratamiento debe ser más agresivo, fundamentado en una resección macroscópicamente completa siempre que se pueda.

En este artículo presentamos el caso de un astrocitoma pilomixoide del tercer ventrículo en el que la fluorescencia con 5-ALA permitió una resección completa, sin signos de recidiva en pruebas de imagen a los 5 años, sin haber precisado tratamiento complementario con radioterapia ni quimioterapia. Se hace además una revisión de la literatura acerca de las características y el manejo de este tumor recientemente considerado como una entidad histopatológica diferente.

Palabras clave:
Resección guiada por fluorescencia
Ácido 5-aminolevulínico
Fluorescencia intraoperatoria
Astrocitoma pilomixoide
Tumor del tercer ventrículo

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