Technical principles in glioma surgery and preoperative considerations

Abstract

The goal of glioma surgery is maximal safe resection. These intrinsic brain neoplasms, however, lack a clear margin and frequently infiltrate eloquent areas of the brain thus making their surgical resection challenging. This review first focuses on discussion of preoperative investigations that aid in anatomical and functional tumor characterization that help define tumor extent and determine the feasibility of complete resection. The second part of this review outlines intraoperative adjuncts that help identify tumor infiltrated tissues during surgery to maximize the extent of resection. In addition, we discuss the principles of intraoperative functional cortical and subcortical mapping and monitoring that enable maximal tumor resection while minimizing the risk of postoperative neurological deficit. Combined use of different modalities before and during surgery is encouraged to meet surgical goals and to ensure best patient outcome.

In Search of a Breakthrough Therapy for Glioblastoma Multiforme

“…Complete surgical resection of GMB is hardly ever possible because the boundaries of GBM are diffuse. The tumor sends "streaks" along nervous tracts and blood vessels, and often surgeons have no choice but to leave certain areas untouched because of the risk of causing severe disabilities in the patients [7].…”

c(RGDyk)-modified nanoparticles encapsulating quantum dots as a stable fluorescence probe for imaging-guided surgical resection of glioma under the auxiliary UTMD

“…According to previous reports, there are many techniques to help maximize the extent of tumour resection. For example, navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) can be checked before surgery, and US navigation and direct cortical stimulation (DCS) can be checked during surgery [45]. However, due to the high cost and limitations of these technologies, they have not been widely used clinically.…”

Diffusion Weighted/Tensor Imaging, Functional MRI and Perfusion Weighted Imaging in Glioblastoma—Foundations and Future

“…The abnormal vascularity found in and around high-grade gliomas may interfere with the BOLD signal resulting in false-negative results. Likewise, perilesional edema and brain plasticity may contribute to false-positive activations ( 44 ).…”