Spontaneous intracerebral haemorrhage secondary to 5-ALA-induced thrombocytopaenia in a paediatric patient: case report and literature review.
Childs Nerv Syst
; 39(4): 1051-1058, 2023 04.
Article
en En
| MEDLINE
| ID: mdl-36662275
ABSTRACT
INTRODUCTION:
The primary objective of neurosurgical management of malignant gliomas is maximal safe resection of the tumour. One of the main obstacles in achieving this is the ability to accurately discriminate between tumour edges and the surrounding healthy brain tissue. The use of fluorescence-guided surgery utilising 5-aminolevulinic acid (5-ALA), first introduced more than 20 years ago, has become an invaluable adjunct in high-grade glioma surgery in adults. However, as 5-ALA is not licensed for use in paediatric patients, the safety profile for such use remains undetermined. CASE REPORT We describe the case of a 4-year-old boy who underwent 5-ALA-guided resection of a fourth ventricle anaplastic ependymoma. Although complete resection was achieved and the patient awoke from surgery well with no neurological deficits, the patient developed acute transaminitis, anaemia, thrombocytopaenia and coagulopathy postoperatively. The patient had a sudden neurological deterioration on postoperative day 2; imaging revealed that he had suffered a spontaneous right frontal intracerebral haemorrhage. The patient returned to theatre for surgical decompression and evacuation of the haematoma, and ultimately went on to make a full recovery.CONCLUSION:
The use of 5-ALA in paediatric patients can be helpful in maximising surgical resection, but the associated safety profile remains undefined. Further research is urgently warranted in order to characterise the efficacy and risk of the use of 5-ALA in the paediatric population.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Trombocitopenia
/
Neoplasias Encefálicas
/
Cirugía Asistida por Computador
/
Glioma
Tipo de estudio:
Etiology_studies
Límite:
Adult
/
Child
/
Child, preschool
/
Humans
/
Male
Idioma:
En
Año:
2023
Tipo del documento:
Article