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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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No glow in the dark – why some gliomas are non-fluorescent: Histopathologic analysis of 140 high-grade gliomas

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  • Anne-Katrin Hickmann - Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital
  • Minou Nadji-Ohl - Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital
  • Oliver Ganslandt - Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 041

doi: 10.3205/15dgnc439, urn:nbn:de:0183-15dgnc4390

Published: June 2, 2015

© 2015 Hickmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Five-Aminolevulinic Acid (5-ALA) has become a valuable adjunct in glioma surgery. Despite intraoperative malignant appearance some gliomas show no 5-ALA-metabolism and remain dark under blue light. We evaluated whether certain histopathologic properties are associated with this phenomenon.

Method: The surgical database was retrospectively searched for patients who underwent fluorescence guided surgery between January 2011 and July 2014 at our institution. Patients with high-grade gliomas were selected for this analysis. Intraoperative fluorescence as documented by the surgeon and results of histopathologic evaluation were analyzed.

Results: 140 high-grade gliomas were analyzed (WHO °III: n = 25, WHO °IV: n = 115). 125 tumors (89.3 %) were fluorescent of which 15 (12 %) showed weak or patchy fluorescence only. Strongly fluorescing tumors were significantly more often WHO °IV tumors (WHO °IV: 91.8 % vs. WHO°III: 8.2 %, p = 0.00). IDH mutations were found significantly more often in non-fluorescing tumors (85.7 % vs. 19.5 %, p = 0.00). In the subgroup analysis this effect remained significant only in WHO °IV tumors. Oligodendroglial differentiation / origin was seen more often in non-fluorescing tumors, without being statistical significant in the subgroup analysis based on WHO-grade (WHO °III: 56.3 % vs. 33.3 %, p = 0.183; WHO °IV: 28.6 % vs. 10.9 %, p = 0.067).

Conclusions: Histologic appearance and molecular tumor characteristics influence 5-ALA metabolism and the ability of tumors to fluoresce under blue light. Further studies on molecular changes and fluorescence may help to establish an interoperative grading system in glioma surgery.