History, Current Status, and Emerging Issue of 5-Aminolevulinic Acid Induced Fluorescence Guided Surgery in Neurological Surgery

Abstract

Fluorescent-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) for malignant brain tumors has been mainly performed with microscopes equipped with emission light source and filter for observation. Recently, endoscope, surgical loupe, and exoscope for 5-ALA-FGS were commercially available, and their usefulness was suggested. Commonly, fluorescence evaluation was based on surgical microscopes accumulated over many years; thus, the fluorescence with these novel fluorescence observational systems should be considered different. Additionally, operators should well understand the cons of the introduction of these novel systems.