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 differen- tiation between malignant glioma and the surrounding edematous brain when using standard white light microscopy. In- traoperative imaging or neuronavigation by preoperative datasets deliver inconsistent results as they often fail to demon- strate 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.

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