Fluorescence-Guided Surgery for Malignant Glioma: A Review on Aminolevulinic Acid Induced Protoporphyrin IX Photodynamic Diagnostic in Brain Tumors

Gross total resection, though proven to be effective, is often hindered by the notoriously challenging differentiation between malignant glioma and the surrounding edematous brain when using standard white light microscopy. Intraoperative imaging or neuronavigation by preoperative datasets deliver inconsistent results as they often fail to demonstrate tumor or resection borders reliably. With the introduction of the 5-aminolevulinic acid (5-ALA, Gliolan®) fluorescence microscopy, neurosurgeons command a highly specific biological tumor marker for malignant glioma resection, to help distinguish the vital tumor tissue from normal brain and improve the extent of tumor removal.