δ-Aminolevulinic acid-induced fluorescence-guided resection of brain tumors

Maximal resection of gliomas is the current standard of care. Various technical adjuncts facilitate this. Aminolevulinic acid (ALA)-induced fluorescence guided resection (FGR) is one such strategy. We review the current literature related to ALA FGR. It is based on the selective uptake of ALA into glioma cells and its preferential conversion to protoporphyrin IX. This selectivity provides a high positive predictive value for ALA induced fluorescence. Since the introduction of this technique, clinical experience supports its efficacy in improving resections in malignant gliomas when compared to other contemporary intraoperative imaging strategies such as the magnetic resonance imaging (MRI) or the adjuncts that exhibit passive permeability like fluorescein. Future research into the understanding of the basis of ALA metabolism in glioma cells and advances in visualization technology will potentially improve the scope of application of this technique.