BACKGROUND: Five-aminolevulinic acid (Gliolan, medac, Wedel, Germany, 5-ALA) is 
approved for fluorescence-guided resections of adult malignant gliomas. Case 
reports indicate that 5-ALA can be used for children, yet no prospective study 
has been conducted as of yet. As a basis for a study, we conducted a survey 
among certified European Gliolan users to collect data on their experiences with 
children.
METHODS: Information on patient characteristics, MRI characteristics of tumors, 
histology, fluorescence qualities, and outcomes were requested. Surgeons were 
further asked to indicate whether fluorescence was "useful", i.e., leading to 
changes in surgical strategy or identification of residual tumor. Recursive 
partitioning analysis (RPA) was used for defining cohorts with high or low 
likelihoods for useful fluorescence.
RESULTS: Data on 78 patients <18 years of age were submitted by 20 centers. 
Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five 
anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III 
(80 %). Fluorescence was found inconsistently useful in PNETs (three of seven; 
43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) 
and pilocytic astrocytomas (two of 13; 15 %). RPA of pre-operative factors 
showed tumors with supratentorial location, strong contrast enhancement and 
first operation to have a likelihood of useful fluorescence of 64.3 %, as 
opposed to infratentorial tumors with first surgery (23.1 %).
CONCLUSIONS: Our survey demonstrates 5-ALA as being used in pediatric brain 
tumors. 5-ALA may be especially useful for contrast-enhancing supratentorial 
tumors. These data indicate controlled studies to be necessary and also provide 
a basis for planning such a study.