EFFECT OF ANTI-EPILEPTIC MEDICATIONS ON INTRAOPERATIVE 5-AMINOLEVULINIC ACID FLUORESCENCE DURING GLIOMA RESECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background Aminolevulinic acid (5-ALA) is a fluorescent dye that holds paramount importance in improving the extent of resection in glioma surgery. However, recent studies have shown that pre-operative administration of anti-epileptic medication (AEM) reduces the fluorescence of 5-ALA in gliomas. Since it is common for individuals with gliomas to require AEM, and 5-ALA is a far more cost-effective mechanism for providing enhanced intraoperative visualization compared to other means, it is crucial to determine if preoperative AEM administration is a factor that influences the visibility of 5-ALA. Objectives We conducted a systematic review and meta-analysis to analyze the impact of AEM on the intraoperative fluorescence of 5-ALA in patients with glioma. Materials & Methods We systematically reviewed four databases till 2022 to retrieve articles that met our inclusion criteria: 1) adult patients with glioma who underwent surgical resection using 5-ALA, 2) studies with both patients with preoperative AEM administration and without AEM administration, 3) Studies that report fluorescence intensity for both groups. Results Four observational studies, with a cumulative 344 patients, were included in the meta-analysis. 41.67% of our cohort were females, with the median age across the articles ranging from 33 to 66 years. 58.14% of patients had grade 4 gliomas, and 59.3% of gliomas were IDH1- wild type. Levetiracetam was the most administered AEM (73.17%). 47.8% were preoperatively given AEM, out of which 56.1% had visible fluorescence intraoperatively. Out of individuals who were not administered AEM, 82.7% had visible fluorescence. Our study found that the preoperative administration of AEM did not affect the visibility of intraoperative fluorescence [OR: 5.16 (0.27- 99.99)]. Conclusions Preoperative administration of AEM in patients with glioma has no impact on the degree of intraoperative fluorescence. We conclude that AEM can be utilized in glioma patients without incurring any risk of reduced visibility secondary to 5 ALA-induced fluorescence in intraoperative functional mapping.