Fluoroscent-Guided Surgery with 5-Aminolevilinic Acid for Meningioma: A Systematic Review and Meta-analysis

Introduction: Managing intracranial tumors with precision remains a formidable challenge. Fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) has become increasingly popular, particularly for malignant gliomas, where it enhances tumor boundary visualization to achieve more complete resections and prolong progression-free survival. Recent research has expanded the use of FGS with 5-ALA to meningiomas, encouraged by its consistent effectiveness in highlighting these tumors.

Objective: This study aims to evaluate the efficacy and safety of FGS in meningiomas.

Methods: We searched Medline, Embase, Cochrane, and Web of Science databases following Cochrane and PRISMA guidelines. Eligible studies included those with ≥4 patients reporting that underwent FGS using 5-ALA. The key endpoints were sympson grades rate, overall complications, and 5-ALA-related complications.

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, II, III, and IV were, respectively, 46% (95% CI: 40–52%), 26% (95% CI: 21–31%), 14% (95% CI: 10–19%), and 18% (95% CI: 13–23%). The overall complication rate was 13% (95% CI: 5–21%), with minor complications at 8% (95% CI: 0–12%) and major complications at 5% (95% CI: 2–8%). 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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Artikel online veröffentlicht:
07. Februar 2025