5-ALA

5-ALA is a specialized technique used during brain tumor surgery that helps the surgeon better see and remove tumor tissue. It uses a fluorescent agent that causes tumor cells to glow under a special light.

Quick Facts:

  • Helps distinguish tumor from normal brain tissue
  • Commonly used for high-grade brain tumors
  • Improves accuracy of tumor removal
  • Used during craniotomy for tumor resection

👉 Request an Appointment
👉 Refer a Patient

WHAT IS 5-ALA?

5-ALA (5-aminolevulinic acid) is a substance that patients take before surgery. Tumor cells absorb this substance differently than normal brain tissue.

During surgery:

  • A special blue light is used
  • Tumor cells glow pink or red
  • Normal brain tissue remains dark

This allows the surgeon to better identify and remove tumor tissue while preserving normal brain.

WHY IS 5-ALA USED?

The goal of brain tumor surgery is maximal safe resection—removing as much tumor as possible while protecting normal brain function.

5-ALA helps by:

  • Improving visualization of tumor margins
  • Identifying tumor that may not be visible under normal lighting
  • Reducing the chance of leaving behind tumor tissue

👉 More accurate surgery can improve outcomes in certain tumor types

WHO IS A CANDIDATE?

5-ALA is most commonly used in patients with:

  • High-grade gliomas (e.g., glioblastoma)
  • Suspected malignant brain tumors
  • Tumors where distinguishing tumor from normal tissue is challenging

It may not be used for:

  • Some benign tumors
  • Tumors that do not take up the fluorescent agent

HOW THE PROCESS WORKS

Step-by-Step Overview

  1. Before Surgery
    • The patient drinks a 5-ALA solution several hours before surgery
  2. During Surgery
    • A craniotomy is performed
    • The tumor is viewed under standard and fluorescent lighting
  3. Fluorescence Visualization
    • Tumor tissue glows under blue light
    • This helps guide removal
  4. Tumor Resection
    • The surgeon removes tumor while preserving normal brain

OUR APPROACH

We use 5-ALA as part of a precision-based surgical strategy.

  • Not every tumor requires 5-ALA
  • We use it selectively when it can improve surgical accuracy
  • It is combined with microsurgical technique and intraoperative guidance
  • The goal is maximal safe tumor removal while preserving neurologic function

👉 Technology supports—but does not replace—careful surgical judgment

WHAT TO EXPECT

Before Surgery

  • Standard preoperative imaging
  • Instructions for taking 5-ALA
  • Discussion of surgical plan

Day of Surgery

  • Performed under general anesthesia
  • Use of specialized lighting during tumor removal

After Surgery

  • Standard postoperative recovery for craniotomy
  • Follow-up imaging to assess tumor removal
  • Additional treatment may be recommended depending on tumor type

OUTCOMES & BENEFITS

Potential Benefits

  • Improved visualization of tumor margins
  • Increased extent of tumor removal
  • More precise surgery
  • Potential improvement in outcomes for certain tumors

Results depend on:

  • Tumor type
  • Location
  • Overall treatment plan

RISKS & CONSIDERATIONS

5-ALA is generally safe, but considerations include:

  • Temporary sensitivity to light after surgery
  • Potential side effects from the medication (rare)
  • Not all tumor tissue fluoresces
  • Must still balance tumor removal with preservation of function

👉 Surgical judgment remains critical even with advanced technology

FREQUENTLY ASKED QUESTIONS

Will 5-ALA guarantee complete tumor removal?

No, but it improves the ability to identify tumor tissue during surgery.

Is this used in every brain tumor surgery?

No. It is used selectively based on tumor type and expected benefit.

Does it change the surgery itself?

It enhances visualization but does not change the overall surgical approach.

Is it safe?

Yes, it is generally well tolerated when used appropriately.

FOR REFERRING PHYSICIANS (Optional Expandable Section)

  • Consider referral for patients with:
    • Suspected high-grade glioma
    • Enhancing brain tumors on MRI
    • Tumors where maximal safe resection is critical
  • Imaging:
    • MRI brain with contrast
  • 5-ALA may be considered as part of:
    • Initial tumor resection
    • Reoperation in select cases

RELATED CONDITIONS / PROCEDURES

  • Brain Tumors
  • Glioblastoma
  • Craniotomy for Tumor Resection
  • Awake Craniotomy
  • Intraoperative Navigation

CALL TO ACTION

👉 Request an Appointment
👉 Refer a Patient