Multimodality program involving stereotactic surgery in brain tumor management

Stereotactic and image guided surgery is becoming increasingly important in the management of brain tumors. Although there are several stereotactic modalities that have been reported to be of value, it is the combination of techniques in a multimodality approach that seems to show the most promise. Both frame-based and frameless guidance may facilitate glioma resection, allowing the optimal amount of resection while permitting avoidance of surrounding eloquent areas. Not only does this optimize resection, but leaving a minimal amount of gross tumor may provide a better bed for intracavitary chemotherapy. Deep tumors may be localized and approached through a small channel. Surgical exposure may be minimized to protect uninvolved areas of the brain. There is increasing evidence that patients operated with imaging guidance have a more benign course and more rapid discharge, perhaps with a lower incidence of adverse neurological sequelae. Stereotactic conformal radiotherapy allows a higher tumor dose while sparing uninvolved brain from radiation more efficiently than conventional radiation. Residual tumor may be treated with a boost of stereotactic radiotherapy. Stereotactic instillation of radioisotope may be used to treat cystic tumors. Stereotactic insertion of cannulae or radioisotope seeds permits efficient brachytherapy. Stereotactic surgery has moved beyond a subspeciality, so that every neurosurgeon might benefit from using stereotactic techniques in brain tumor management.