ArticleNeurosurgery practice2023
Stereotactic DOTATATE Positron Emission Tomography/Computed Tomography-Guided Resection of a Multiply Recurrent World Health Organization Grade 2 Parasagittal Meningioma: A Technical Case Report.
Article in Neurosurgery practice, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and importanceResection of parasagittal meningiomas is challenging due to venous and superior sagittal sinus involvement. Recurrent tumors can be particularly challenging given scar tissue from prior surgery and radiation, which can be difficult to differentiate from active tumor on preoperative MRI. Cu-64-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE) is a somatostatin receptor (SSTR) ligand detectable on positron emission tomography (PET) imaging. SSTR is expressed by most meningiomas. While DOTATATE-PET has been investigated for radiotherapy planning, its use in guiding oncological meningioma resection is understudied. Here, we present a case example demonstrating its use in guiding surgical planning and maximizing the extent of resection. CLINICAL PRESENTATION: A 45-year-old man with a World Health Organization grade 2 bilateral parasagittal meningioma presented with recurrence after 2 prior resections, wound infection and washout, and fractionated radiotherapy with boost to residual disease. Preoperative angiography demonstrated an occluded sagittal sinus beyond the extent of the residual tumor. Stereotactic DOTATATE PET-computed tomography (CT) imaging was integrated with the neuro-navigation and used intraoperatively to identify extent of active tumor, differentiating it from scar tissue and gliosis. This was used to facilitate oncological tumor resection with negative pathological margins that correlated with the absence of DOTATATE signal.
conclusionStereotactic DOTATATE PET-CT is a valuable addition to the neurosurgeon's toolkit, particularly when integrated into the neuro-navigation, for achieving complete resections of recurrent meningiomas, or meningiomas where the extent of tumor invasion can be challenging to define on preoperative MRI.
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