Journal of Neuro-Oncology

, Volume 141, Issue 3, pp 533–546 | Cite as

Fluorescence guided surgery by 5-ALA and intraoperative MRI in high grade glioma: a systematic review

  • Jan CoburgerEmail author
  • Christian Rainer Wirtz
Topic Review



Fluorescence guided surgery by 5-aminolevulinic acid (5-ALA) and intraoperative MRI (iMRI) are currently the most important intraoperative imaging techniques in high grade glioma (HGG) surgery. Few comparative studies exist for these techniques. This review aims to systematically compare 5-ALA and iMRI assisted surgery based on the current literature and discuss the potential impact of a combined use of both techniques.


A systematic literature search based on preferred reporting items for systematic reviews and meta-analysis was performed concerning accuracy of tumor detection; extent of resection; neurological deficits (ND); Quality of life (QoL); usability and combined use of both techniques. Original clinical articles on HGG published until March 31st were screened.


169 publications were screened, 81 were eligible and 22 were finally included in the review using. Overall, there is evidence that both imaging techniques improve gross total resection rate in non-eloquent lesions. Imaging results do not correlate at the border zone of a HGG. 5-ALA and contrast-enhanced iMRI seem to have a supplementary effect in tumor detection. Overall, both imaging techniques alone or combined do not seem to increase rate of permanent ND or decrease QoL in HGG surgery when used with intraoperative monitoring/mapping.


Based on the currently available literature no superiority of one technique over the other can be found in the most important outcome parameters. Based on the available information a combined use of 5-ALA and iMRI seems very promising to achieve a resection beyond gadolinium-enhancement. However, only low quality of evidence exists for this approach.


5-ALA iMRI Extent of resection Neurological deficit Usability Quality of life PRISMA 


Compliance with ethical standards

Conflict of interest

The author JC works as a consultant for Brainlab AG, München, Germany and received speaker fees from the same company.


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Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of UlmGünzburgGermany

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