Fluorescence-Guided Resection of High-Grade Glioma Using 5-Aminolevulinic Acid
DOI:
https://doi.org/10.5281/zenodo.22310507Keywords:
5-aminolevulinic acid, Fluorescence-guided surgery, High-grade glioma, Glioblastoma, Extent of resectionAbstract
Background: High-grade gliomas are treated with maximal safe resection plus radiotherapy and temozolomide. Extent of
resection predicts survival, but infiltrative margins resist visual discrimination under white light. Objective: To review 5-aminolevulinic acid (5-ALA) fluorescence-guided resection of high-grade glioma, covering mechanism, the pivotal trial, comparative modalities, and limitations. Methods: Narrative review of randomized trials, long-term follow-up, systematic reviews, meta-analyses, and mechanistic and health-economic literature. Findings: The pivotal randomized trial found complete resection in 65% of 5-ALA-guided patients versus 36% under white light, with higher six-month progression-free survival. Subsequent meta-analyses, registries, and head-to-head trials againstintra operative MRI confirm greater resection extent and a favorable cost profile, alongside recognized limitations at infiltrative margins and uneven global access. Conclusions: 5-ALA fluorescence guidance is a validated, cost-effective surgical adjunct that measurably improves resection extent in high-grade glioma, though it cannot fully resolve diffusely infiltrative margins and remains inconsistently available worldwide.
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