Intraoperative and postoperative gamma detection of somatostatin receptors in bone-invasive en plaque meningiomas.
OBJECTIVE
Scintigraphy with a radiolabeled somatostatin analog ((111)In-diethylenetriaminepenta-acetic acid octreotide) detects the somatostatin receptors that are found in vitro in all meningiomas. Previous studies have proved the benefit of radioimmunoguided surgery, with a hand-held gamma probe, for the assessment and removal of neuroendocrine tumors. We conducted a study to determine whether intraoperative radiodetection of somatostatin receptors is feasible and could increase the probability of complete meningioma resection, especially for bone-invasive en plaque meningiomas, which are difficult to control surgically.


METHODS
Eighteen patients with en plaque sphenoid wing and cranial convexity meningiomas were studied by preoperative and postoperative somatostatin receptor scintigraphy. In 10 of them, intraoperative radiodetection with a hand-held gamma probe was performed 24 hours after the intravenous administration of (111)In-diethylenetriaminepenta-acetic acid octreotide. This procedure was combined with a computer-aided navigation system.


RESULTS
All preoperative scintigrams were positive. Intraoperative gamma probe detection was achieved for the invaded bone, dura, and periorbit of sphenoid wing meningiomas. The average tumor/nontumor count ratio was 2:1, with a maximum of 12:1, thus allowing precise detection capable of defining the tumor margins. In three cases of sphenoid wing meningiomas, postoperative scintigrams were helpful for the determination of recurrences that magnetic resonance imaging failed to detect.


CONCLUSIONS
These preliminary data show that intraoperative radiodetection of somatostatin receptors with a hand-held gamma probe is feasible and may be helpful to guide the surgical removal of bone-invasive en plaque meningiomas. Preoperative and postoperative scintigraphy may be useful for the management and follow-up of patients with these tumors.
Department of Neurosurgery, University Hospital, Grenoble, France. EGay@chu-grenoble.fr
Emmanuel
E
Gay
Jean Philippe
JP
Vuillez
Olivier
O
Palombi
Pierre Yves
PY
Brard
Pierre
P
Bessou
Jean Guy
JG
Passagia
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015282:Octreotide / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D017481:Receptors, Somatostatin / Q000378:metabolism*; D012888:Skull Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; C094279:indium-111-octreotide; D015282:Octreotide