“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”

Abstract Object 5-aminolevulinic acid (5-ALA) was increasingly used in the last years to identify anaplastic foci in primarily suspected low-grade gliomas (LGG). However, 5-ALA fails to visualize a subgroup of focally anaplastic gliomas. Recently, two in-vitro studies and one in-vivo study assumed that antiepileptic drugs (AED) and dexamethasone have an influence on the 5-ALA metabolism/visible fluorescence in gliomas. The aim of this study was thus to analyze for the first time the influence of different AED and dexamethasone on visible 5-ALA fluorescence in a large cohort of suspected LGG. Methods We retrospectively analyzed adult patients with resection of radiologically suspected diffusely infiltrating LGG after 5-ALA administration at two specialized centers. Clinical data on the intraoperative 5-ALA fluorescence status, preoperative treatment with AED/dexamethasone and the total daily dose in case of levetiracetam and dexamethasone intake were noted. Results Altogether, 110 patients with suspected LGG were included. A significantly higher percentage of visible fluorescence was present in WHO grade III/IV (73%) compared to WHO grade II gliomas (11%; p Conclusions In the largest series to date, we did not find a drug-related influence of either dexamethasone nor 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.