title: Glioma Surgery: Technological Advances to Achieve a Maximal Safe Resection.
abstract: Glioblastoma multiforme (GBM) is the most frequent primary central nervous system (CNS) tumor. Despite the best treatment and advances in therapy, prognosis remains poor. One of the mainstays of therapy in GBM is surgical excision. Several studies have confirmed that the extent of resection (EOR) positively influences overall survival (OS) in patients with high-grade gliomas (HGGs). A literature search was performed using PubMed to assess the useful neurosurgical tools to achieve the best neurosurgical performance. In order to achieve the major extent of resection, preserving neurological function, many tools are now available, especially neuronavigation, intraoperative fluorescence, intraoperative ultrasound, and neuromonitoring. In addition to the maximal excision of tumor, the neurosurgeon can use photodynamic therapy (PTD) and local drug delivery (LDD) to improve the local control and bridge conventional radio and chemotherapy. EOR improves OS in patients with HGGs. There are technological possibilities for achieving a complete resection preserving neurological function, and it is not acceptable to perform only biopsy of these lesions.
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Altieri
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zenga
authors.affiliation: Department of Neurosurgery, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Marco Maria
authors.initials: MM
authors.lastname: Fontanella
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cofano
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Agnoletti
authors.affiliation: Department of Neurosurgery, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Spena
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Crobeddu
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Fornaro
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ducati
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Garbossa
mesh_terms: D016503:Drug Delivery Systems; D005909:Glioblastoma / Q000601:surgery*; D006801:Humans; D038361:Neuronavigation; D019635:Neurosurgical Procedures; D010789:Phototherapy