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Meta-Analysis
. 2025 Jul 7;48(1):545.
doi: 10.1007/s10143-025-03699-4.

Efficacy and safety of 5-aminolevulinic acid in meningioma resection: a systematic review and meta-analysis

Lucca B Palavani  1 , Gean Carlo Müller  2 , Bernardo Vieira Nogueira  3 , Hsien-Chung Chen  4   5 , Vinicius G Pereira  6 , Mariano Belfort Santos  7 , Anna Luiza Pereira  6 , Carlos Alexandre Farias  8 , Fabiana Honorato  9 , Dan Zimelewicz Oberman  10 , Danilo Silva  11
Affiliations
Meta-Analysis

Efficacy and safety of 5-aminolevulinic acid in meningioma resection: a systematic review and meta-analysis

Lucca B Palavani et al. Neurosurg Rev. .

Abstract

Background: Fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) has gained popularity in managing malignant gliomas by improving tumor boundary visualization, enabling more complete resections, and prolonging progression-free survival (PFS). Recent research has expanded its use to meningiomas, encouraged by its consistent effectiveness in highlighting these tumors. This study aims to evaluate the efficacy and safety of FGS in meningiomas.

Methods: We searched PubMed, Embase, Cochrane, and Web of Science databases following Cochrane and PRISMA guidelines. Eligible studies included those with ≥ 4 patients reporting patients with meningioma who underwent FGS using 5-ALA. Key endpoints included positive fluorescence, fluorescence intensity, Simpson grade, and surgical complications.

Results: Data from nine studies, encompassing 361 patients (108 males and 253 females) with a mean age of 59.1 years, were analyzed. A high positive fluorescence rate of 95% (95% CI: 92-98%) was found. Strong fluorescence rate occurred in 81% (95% CI: 65-97%), while weak fluorescence was found in 18% (95% CI: 3-34%). According to the Simpson grading system, 80% (95% CI: 65-95%) achieved grades I and II, while 20% (95% CI: 5-35%) reached grades III and IV. Surgical complications occurred in 10% (95% CI: 2-18%). No complications were directly related to 5-ALA.

Conclusion: The study indicates that 5-ALA-guided FGS is safe for meningiomas and improves their Simpson grade, with higher rates of Simpson grades I and II. This underscores the utility of 5-ALA as a valuable tool in the surgical management of meningiomas.

Clinical trial number: Not applicable.

Keywords: 5-ALA; Aminolevulinic acid; Fluorescence guided surgery; Meningioma.

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Conflict of interest statement

Declarations. Ethics approval: Not applicable as this is a systematic review per PRISMA Guidelines. Consent for publication: All authors consent to publication, and this study has not been accepted for publication elsewhere. Consent to participate: Not relevant, as no individual patient data was used. Disclosures: All authors report no relationships that could be construed as a conflict of interest. They also take responsibility for the reliability and freedom from bias of the data presented and their discussed interpretation. Competing interests: The authors declare no competing interests.

References

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