Fluorescence-Guided Resection of High-Grade Glioma Using 5-Aminolevulinic Acid

Background: High-grade gliomas are treated with maximal safe resection plus radiotherapy and temozolomide. Extent ofresection 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, thepivotal trial, comparative modalities, and limitations.Methods: Narrative review of randomized trials, long-term follow-up, systematic reviews, meta-analyses, and mechanistic andhealth-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 againstintraoperative MRI confirm greater resection extent and a favorable cost profile, alongside recognized limitations at infiltrativemargins and uneven global access.Conclusions: 5-ALA fluorescence guidance is a validated, cost-effective surgical adjunct that measurably improves resectionextent in high-grade glioma, though it cannot fully resolve diffusely infiltrative margins and remains inconsistently availableworldwide