Abstract：
Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is used to assist brain tumor resection, especially for high-grade gliomas but also for low-grade gliomas, metastasis, and meningiomas. With the increasing use of this technique, even to assist biopsies, high-grade glioma-mimicking lesions had misled diagnosis by showing 5-ALA fluorescence in non-neoplastic lesions such as radiation necrosis and inflammatory or infectious disease. Since only isolated reports have been published, we systematically review papers reporting non-neoplastic lesion cases with 5-ALA according with the PRISMA guidelines, present our series, and discuss its pathophysiology. In total, 245 articles were identified and 12 were extracted according to our inclusion criteria. Analyzing 27 patients, high-grade glioma was postulated as preoperative diagnosis in 48% of the cases. Microsurgical resection was performed in 19 cases (70%), while 8 patients were submitted to biopsy (30%). We found 4 positive cases in demyelinating disease (50%), 4 in brain abscess (80%), 1 in neurocysticercosis (33%), 1 in neurotoxoplasmosis, infarction, and hematoma (100%), 4 in inflammatory disease (80%), and 3 in cortical dysplasia (100%). New indications are being considered especially in benign lesion biopsies with assistance of 5-ALA. Using fluorescence as an aid in biopsies may improve procedure time, number of samples, and necessity of intraoperative pathology. Further studies should include this technology to encourage more beneficial uses.
摘要：
使用5-氨基乙酰丙酸（5-ALA）的荧光引导手术用于辅助脑肿瘤切除，特别是对于高级别胶质瘤，也对于低级别胶质瘤，转移,和脑膜瘤.随着这项技术的使用越来越多，甚至协助活检，在非肿瘤性病变如放射性坏死和炎症或感染性疾病中显示5-ALA荧光,模拟高级别神经胶质瘤的病变误导了诊断.由于只发表了孤立的报告，我们根据PRISMA指南系统地回顾报告5-ALA非肿瘤性病变病例的论文，介绍我们的系列,并讨论其病理生理学。总的来说,根据我们的纳入标准，共确定了245篇文章，提取了12篇。分析27名患者，在48%的病例中,高级别胶质瘤被假定为术前诊断.显微手术切除19例(70%),而8例患者接受活检（30％）。我们发现4例脱髓鞘病阳性（50%），4在脑脓肿（80％），1在脑囊虫病（33%），1在神经弓形虫病中，梗塞,血肿（100%），4在炎症性疾病中(80%)，皮质发育不良3（100%）。在5-ALA的协助下，尤其是在良性病变活检中，正在考虑新的适应症。使用荧光作为辅助活检可以改善手术时间，样品数量,术中病理的必要性。进一步的研究应该包括这项技术，以鼓励更多的有益用途。
