Background 5-Aminolevulic Acid guided surgery (5-ALA-GS) improves the extent of resection and progression free survival in patients with glioblastoma multiforme (GBM). Methods Single-center retrospective cohort study of adult patients with GBM who had surgical resection between 2013 and 2019, 5-ALA guided versus a non 5-ALA cohort. Primary outcome was the overall survival (OS). Secondary outcomes were extent of resection (EoR), performance status (PS), and new focal neurological deficit. Results 343 patients were included: 253 patients in 5-ALA-GS Group and 90 patients in the non-5-ALA-GS Group. The OS (17.47 versus 10.63 months, p<0.0001), post-operative PS (p<0.0001), PS at 6 months (p=0.002), new focal neurological deficit (23.3% versus 44.9%, p<0.0001) and radiological EoR (gross total resection (GTR) - 47.4% versus 22.9%, p< 0.0001) were significantly better in the 5-ALA-GS Group compared to non-5-ALA-GS Group. In multivariate analysis, use of 5-ALA (p=0.003) and MGMT promoter methylation (p=0.001) were significantly related with a better OS. In patients with radiological GTR, OS was also significantly better (p<0.0001) in the 5-ALA-GS Group compared to the non-5-ALA-GS Group. Conclusions 5-ALA guided surgery is associated with a significant improvement in the OS, PS after surgery and at six months, larger EoR, and fewer new motor deficits in patients with GBM.

Background Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees’ operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. Methods PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. Results Neurosurgical skills assessed included aneurysm clipping ( n = 6), craniotomy and burr hole drilling ( n = 2), tumour resection ( n = 4), and vessel suturing ( n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models ( n = 5), synthetic models ( n = 7), and VR models ( n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. Conclusion Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05003-x.