Photodynamic therapy (PDT) is a two-step treatment involving the local administration of a photosensitive agent followed by its activation at a specific light wavelength. PDT has been approved by the United States Food and Drug Administration (FDA) for the treatment of premalignant and malignant diseases, such as actinic keratoses, Barrett's esophagus, esophageal cancers, and endobronchial non-small cell lung cancers, as well as for the treatment of choroidal neovascularization. In oncology, clinical trials are currently underway to demonstrate PDT efficacy against a number of malignancies that include glioblastoma (GBM) and other brain tumors. Both photosensitizers and photosensitizing precursors have been used for PDT. Photofrin and Visudyne are photosensitizers with FDA approval for PDT of high-grade dysplasia in Barrett's esophagus and subfoveal choroidal neovascularization, respectively. 5-aminolevulinic acid (5-ALA), an intermediate in the heme synthesis pathway, is a photosensitizing precursor with FDA approval for PDT of actinic keratosis and fluorescence-guided visualization of malignant tissue during glioma surgery. In this review, the history and current use of 5-ALA PDT for the treatment of high-grade gliomas (HGGs) will be discussed.