Intraoperative Imaging and Optical Visualization Techniques for Brain Tumor Resection: A Narrative Review

Abstract

Advancements in intraoperative visualization and imaging techniques are increasingly central to the success and safety of brain tumor surgery, leading to transformative improvements in patient outcomes. This comprehensive review intricately describes the evolution of conventional and emerging technologies for intraoperative imaging, encompassing the surgical microscope, exoscope, Raman spectroscopy, confocal microscopy, fluorescence-guided surgery, intraoperative ultrasound, magnetic resonance imaging, and computed tomography. We detail how each of these imaging modalities contributes uniquely to the precision, safety, and efficacy of neurosurgical procedures. Despite their substantial benefits, these technologies share common challenges, including difficulties in image interpretation and steep learning curves. Looking forward, innovations in this field are poised to incorporate artificial intelligence, integrated multimodal imaging approaches, and augmented and virtual reality technologies. This rapidly evolving landscape represents fertile ground for future research and technological development, aiming to further elevate surgical precision, safety, and, most critically, patient outcomes in the management of brain tumors.

Intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice

“…В огляді O. Bin-Alamer et al наведено сучасні підходи до інтраопераційної візуалізації в нейрохірургічній практиці, зокрема застосування ICG та інших вітальних барвників [37].…”

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

“…In vascular neurosurgery, the shift from surgical aneurysm clipping to endovascular coiling techniques has required neurosurgeons and neuroendovascular surgeons to gain proficiency in catheter-based procedures, underscoring the necessity for ongoing education in emerging technologies ( Day et al, 2017 ). Oncology has seen a similar evolution, with the introduction of intraoperative MRI and fluorescence-guided surgery allowing for more accurate tumor resections ( Bin-Alamer et al, 2023 ). These developments across spine, vascular, and oncological neurosurgery exemplify the need for a multidisciplinary approach, integrating knowledge from radiology, oncology, and neurology, to provide comprehensive patient care and navigate the complexities of modern neurosurgical interventions.…”

Discriminating Glioblastoma from Normal Brain Tissue In Vivo Using Optical Coherence Tomography and Angiography: A Texture and Microvascular Analysis Approach

“…Fluorescent-guided techniques use fluorescent agents to visualize the tumor area. While this method can address the challenges posed by brain shift, it cannot detect low-grade gliomas, and tumor tissues may exist outside the fluorescent areas [16]. In general, these techniques are constrained by imaging resolution limits, making it challenging to accurately delineate small tumor regions or define the margins between normal and cancerous tissues.…”