title: Clinical experience of glioma surgery using "tailed bullet": overcoming the limitations of conventional neuro-navigation guided surgery.
abstract: OBJECTIVE
  Although conventional neuro-navigation is a useful tool for image-guided glioma surgery, there are some limitations, such as brain shift. We introduced our methods using an identifiable marker, a "tailed bullet", to overcome the limitation of conventional neuro-navigation. A tailed bullet is an identifiable tumor location marker that determines the extent of a resection and we have introduced our technique and reviewed the clinical results.
  
  
  METHODS
  We have developed and used "tailed bullets" for brain tumor surgery. They were inserted into the brain parenchyma or the tumor itself to help identify the margin of tumor. We retrospectively reviewed surgically resected glioma cases using "tailed bullet". Total 110 gliomas included in this study and it contains WHO grade 2, 3, and 4 glioma was 14, 36, and 60 cases, respectively.
  
  
  RESULTS
  Gross total resection (GTR) was achieved in 71 patients (64.5%), subtotal resection in 36 patients (32.7%), and partial resection in 3 patients (2.7%). The overall survival (OS) duration of grade 3 and 4 gliomas were 20.9 (range, 1.2-82.4) and 13.6 months (range, 1.4-173.4), respectively. Extent of resection (GTR), younger age, and higher initial Karnofsky Performance Status (KPS) score were related to longer OS for grade-4 gliomas. There was no significant adverse event directly related to the use of tailed bullets.
  
  
  CONCLUSIONS
  Considering the limitations of conventional neuro-navigation methods, the tailed bullets could be helpful during glioma resection. We believe this simple method is an easily accessible technique and overcomes the limitation of the brain shift from the conventional neuro-navigation. Further studies are needed to verify the clinical benefits of using tailed bullets.
authors: Department of Neurosurgery, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea.
authors: Jin Mo
authors: JM
authors: Cho
authors: Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea.
authors: Jae Joon
authors: JJ
authors: Lim
authors: Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
authors: Se-Hyuk
authors: SH
authors: Kim
authors: Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea. sandori50@gmail.com.
authors: Kyung Gi
authors: KG
authors: Cho
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Glioma; image-guided surgery; neuro-navigation; tailed bullet