Introduction: Managing intracranial tumors with precision poses an enduring challenge in neurosurgery. Fluorescence-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) has gained significant traction, particularly for malignant gliomas, where it enhances visualization of tumor boundaries, enabling more extensive resections and improving progression-free survival outcomes. Encouraged by its proven efficacy in gliomas, recent studies have explored the application of 5-ALA FGS in meningiomas, demonstrating promising potential in accurately delineating these tumors. This study aims to comprehensively assess the efficacy and safety of FGS with 5-ALA in the treatment of meningiomas.
Methods: We conducted a systematic search across Medline, Embase, Cochrane, and Web of Science databases, adhering to Cochrane and PRISMA guidelines. Studies were eligible if they included at least four patients who underwent fluorescence-guided surgery (FGS) using 5-ALA for meningioma treatment. The primary endpoints assessed were Simpson grade resection rates, overall complication rates, and complications specifically associated with 5-ALA use.
Results: Data from seven studies, encompassing 309 patients with a median age ranging from 57 to 63.2 years (99 males and 210 females), were analyzed. Using the Simpson grading system for meningioma treatment, the proportions achieving grades I and II, and III and IV were respectively 81% (95% CI: 71%-91%), and 20% (95% CI: 8%-32%). The overall complication rate was 8% (95% CI: 1%-16%), with minor complications at 3% (95% CI: 1%-4%) and major complications at 4% (95% CI: 1%-7%). There were no complications directly related to the use of 5-ALA.
Conclusion : The study evidence suggests that using 5-ALA for FGS surgeries for meningiomas is safe and enhances the Simpson grade of those tumors by showing higher rates of Simpson grades I and II. This underscores the utility of 5-ALA as a possible valuable tool in the surgical management of meningiomas.
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