Surgical management for supratentorial astrocytic tumors

To compare the surgical treatment of supratentorial astrocytic tumors, various methods were performed by the same surgeon. Removal of the tumor was performed using stereotactic open surgery, the fluorescein surgical microscope, and a frameless stereotactic system, and these methods were compared. The method using the stereotactic technique was useful because there was no disturbance by the shifting of the brain during the operation. However, its limitation was that only points can be marked. The fluorescein surgical microscope was very useful in the cases where neuroradiological images were enhanced by the contrast medium, but deep lesions could not be identified from the brain surface. This method could not be used, either, in the case of images that were not enhanced. By the method using the frameless stereotactic system, identification of tumors including deep lesions was possible from every direction, but the problems were the mobility of the registered skin and the shifting of the brain during the operation. On the basis of these results, the combined method of the fluorescein surgical microscope and the frameless stereotactic system appeared to be useful when neuroradiological images of lesions were enhanced because these methods were complementary towards each other, and the frameless stereotactic system supplemented by the stereotactic open surgery technique (such as leaving a marker in deep lesions just before the start of microsurgery) seemed useful when images could not be enhanced.