title: Emerging operative strategies in neurosurgical oncology.
abstract: OBJECTIVE
  In recent years, the safety and efficacy of neurosurgical intervention has rapidly improved for brain tumor patients. Technological advances, combined with refined intraoperative techniques, now enable well tolerated surgical access to any region of the human brain. For patients with gliomas, these improvements have redefined the clinical possibilities, and here we review several emerging operative strategies that are essential for next-generation neurosurgical oncologists and major brain tumor centers.
  
  
  RESULTS
  The value of glioma extent of resection remains controversial, but review of the modern literature reveals important opportunities for early neurosurgical intervention. Although microsurgical resection must be balanced by the risk of neurological compromise, improvements in intraoperative stimulation techniques now enable resection of highly eloquent tumors with minimal morbidity. Additionally, the emergence of fluorescence-guided surgery as a new operative paradigm provides a unique opportunity to resect tumors to the margins of microscopic infiltration.
  
  
  CONCLUSIONS
  Neurosurgical intervention remains the first step in effective glioma management. With intraoperative mapping techniques, aggressive microsurgical resection can be safely pursued even when tumors occupy essential functional pathways. With the development of tumor-specific fluorophores, such as 5-aminolevulinic acid, real-time microscopic visualization of tumor infiltration can be surgically targeted prior to adjuvant therapy.
authors.affiliation: Division of Neurosurgical Oncology, Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona 85013, USA. nader.sanai@bnaneuro.net
authors.forename: Nader
authors.initials: N
authors.lastname: Sanai
mesh_terms: D000622:Aminolevulinic Acid; D001921:Brain / Q000502:physiology / Q000601:surgery*; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000601:surgery*; D005910:Glioma / Q000601:surgery*; D006801:Humans; D018613:Microscopy, Confocal / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D017319:Photosensitizing Agents
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid