MARCH 2021 | The Surgical Technologist | 111 One of the greatest chal lenges in the surgical treatment of mal ignant gl iomas revolves around the v isual izat ion and subsequent resect ion of tumor margins. This is where fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) oral solution comes into play. L E A R N I N G O B J E C T I V E S ▲ Learn about fluorescence-guided surgery for the treatment of malignant gliomas ▲ Evaluate the pathophysiology prompting surgical intervention for this procedure ▲ Identify the supplies and equipment used during this procedure ▲ Review the procedural steps required during a 5-ALA fluorescence-guided resection of malignant gliomas ▲ List the special considerations needed for this procedure T his method utilizes tumor marking that permit the sur- geon to have real-time intraoperative guidance and visu- alization of glioma tumor borders. The 5-ALA method can be independent of or work in tangent with stereotactic neuro- navigation that allows direct real time visualization to differenti- ate the tumor from normal neural tissue. 5-ALA is delivered orally in a prepared solution to the patient approximately three hours prior to surgery. It is associated with unprecedented predictive ability for identifying malignant glioma tissue. Tumor dissection often utilizes white light microscopy, unlike the blue light microscopy used with 5-ALA. To this end, 5-ALA FGS has aided in achieving a significantly higher rate of complete resections in malignant gliomas cases. 5-ALA FGS has been found to be a reliable surgical technique and quickly has become the standard of care at many neurosurgical departments globally. 2 Initially this method was introduced by Dr. Walter Stum- mer in 1998. Stummer and his team conducted a trail in Europe that demonstrated the efficacy of this technique. He was able to 5-ALA Fluorescence-Guided Resection of Malignant Gliomas Jeffrey Anderson, cst