Technical principles in glioma surgery and preoperative considerations.
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.
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030, USA.|Division of Neurosurgery, Department of Clinical Neurological Sciences, The University of Western Ontario, London, ON, Canada.
Daria
D
Krivosheya
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030, USA. sprabhu@mdanderson.org.
Sujit S
SS
Prabhu
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030, USA.
Jeffrey S
JS
Weinberg
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030, USA.
Raymond
R
Sawaya
D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D004558:Electric Stimulation; D005910:Glioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D064795:Intraoperative Neurophysiological Monitoring; D059906:Neuroimaging; D038361:Neuronavigation; D019635:Neurosurgical Procedures; D011300:Preoperative Care
Awake craniotomy; Cortical mapping; Direct electrical stimulation; Eloquent; Glioma surgery; Monitoring