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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Impact of antiepileptic drug treatment on 5-aminolevulinic acid fluorescence expression in IDH-1 wild-type glioblastoma

Einfluss von Antiepileptika auf die 5-ALA Fluoreszenz bei IDH-1 wild-typ Glioblastomen

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  • presenting/speaker Johannes Wach - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Ági Güresir - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Motaz Hamed - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Ulrich Herrlinger - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Albert Becker - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Erdem Güresir - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV227

doi: 10.3205/22dgnc219, urn:nbn:de:0183-22dgnc2191

Published: May 25, 2022

© 2022 Wach 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: 5-aminolevulinic acid (5-ALA) is the most established neurosurgical fluorescent dye and facilitates the achievement of gross total resection in glioblastoma (GB). In-vitro studies raised the concern that antiepileptic drugs (AED) might reduce the fluorescence quality.

Methods: Between 2013 and 2018, 175 isocitrate-dehydrogenase-1 (IDH-1) wild-type glioblastoma patients underwent 5-ALA guided surgery. Patients’ data were retrospectively reviewed regarding demographics, comorbidities, medications, tumor morphology, neuropathological characteristics, and their association with intraoperative 5-ALA fluorescence. 5-ALA fluorescence was graded in a 3-point scaling system (grade 0 = no; grade 1 = weak; grade 2 = strong).

Results: Univariable analysis showed that the intake of dexamethasone or AEDs, and larger preoperative tumor areas significantly reduced the intraoperative fluorescence activity (Fluorescence grades: 0+1). Twenty-six (78.8%) out of 33 patients with either no or only weak fluorescence grades (grades 0+1) took antiepileptic drugs prior to surgery, whereas only 7 (22.2%) patients with fluorescence grades 0 or 1 had no AEDs in their preoperative medication (Fisher´s exact test (two-sided): p = 0.001). Multivariable binary logistic regression analysis demonstrated the preoperative intake of AEDs (adjusted odds ratio: 14.71, 95% confidence interval: 4.65-46.58, p = 0.001) as the only independent and significant risk factor for reduced fluorescence quality (Fluorescence grades: 0+1).

Conclusion: Preoperative antiepileptic drugs seem to significantly reduce intraoperative fluorescence. Indication for AEDs in suspected GB might be carefully reviewed and prophylactic treatment should be avoided in this tumor entity. Future comparative trials of neurosurgical fluorescent dyes might have a special focus on this endpoint. Further trials have to validate our findings.