Established and emerging uses of 5-ALA in the brain: an overview

Introduction: 5-aminolevulinic acid (5-ALA) was approved by the FDA in June 2017 as an intra-operative optical imaging agent for patients with gliomas (suspected World Health Organization Grades III or IV on preoperative imaging) as an adjunct for the visualization of malignant tissue during surgery. 5-ALA fluorescence-guided surgery (FGS) has been in widespread use in Europe and other continents since 2007. Methods: We reviewed the data available and summarize the most important known uses of 5-ALA FGS and its potential future applications. Results/conclusions: The technique has been extensively studied, and more than 300 papers have been published on this topic. Visualization of high-grade glioma tissue is robust and reproducible, and can impact the extent of tumor resection and patient outcomes. 5-ALA FGS for other kind of tumors needs further development. Graphical abstract: [Figure not available: see fulltext.].