• World Neurosurg · May 2020

    "Influence of corticosteroids and antiepileptic drugs on visible 5-ALA fluorescence in a series of initially suspected low-grade gliomas including WHO grade II, III and IV gliomas".

    • Lisa I Wadiura, Mario Mischkulnig, Arthur Hosmann, Martin Borkovec, Barbara Kiesel, Thomas Rötzer, Petra A Mercea, Julia Furtner, Shawn Hervey-Jumper, Karl Rössler, Mitchel S Berger, and Georg Widhalm.
    • Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center-Central Nervous System Tumours Unit, Medical University of Vienna, Vienna, Austria.
    • World Neurosurg. 2020 May 1; 137: e437-e446.

    Objective5-aminolevulinic acid (5-ALA) has been increasingly used in recent years to identify anaplastic foci in primarily suspected low-grade gliomas (LGGs). However, 5-ALA fails to visualize a subgroup of focally anaplastic gliomas. Recently, 2 in vitro studies and 1 in vivo study assumed that antiepileptic drugs (AEDs) and dexamethasone have an influence on the 5-ALA metabolism/visible fluorescence in gliomas. The aim of this study was to analyze for the first time the influence of different AEDs and dexamethasone on visible 5-ALA fluorescence in a large cohort of suspected LGG.MethodsWe retrospectively analyzed adult patients with resection of radiologically suspected diffusely infiltrating LGG after 5-ALA administration at 2 specialized centers. Clinical data on the intraoperative 5-ALA fluorescence status, preoperative treatment with AED/dexamethasone, and the total daily dose in cases of levetiracetam and dexamethasone intake were noted.ResultsAltogether, 110 patients with suspected LGG were included. A significantly higher percentage of visible fluorescence was present in World Health Organization grade III/IV (73%) compared with World Health Organization grade II gliomas (11%; P < 0.001). In the multivariate analysis, we did not find an independent correlation between the visible fluorescence status and intake of dexamethasone/AED. Furthermore, the median daily dose of dexamethasone and levetiracetam did not differ significantly between fluorescing and nonfluorescing gliomas.ConclusionsIn the largest series to date, we did not find a drug-related influence of either dexamethasone or different AED on visible 5-ALA fluorescence in suspected LGG. According to our preliminary data, preoperative treatment with these common drugs in neurosurgery can be performed safely before 5-ALA-assisted surgery of suspected LGG.Copyright © 2020 Elsevier Inc. All rights reserved.

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