Bioimaging and surgery of brain tumors

Bioimaging of brain tumors using nuclear medicine techniques complements computed tomography (CT) and magnetic resonance imaging (MRI), thus allowing more accurate diagnosis in clinically ambiguous situations. Special tracers for positron emission tomography (PET) have been developed which allow monitoring and planning of therapy. PET data may provide also presurgical evidence with regard to the presence of clinically relevant molecular brain tumor biomarkers. Combined PET/CT and PET/MR hybrid imaging systems will further enhance bioimaging-based brain tumor analysis. The main aim of brain tumor surgery is maximal safe tumor resection with preservation of neurologic functions, and to relieve tumor-related symptoms. In deep-seated unresectable tumors, diagnostic biopsy may be the main surgical goal. Special pre- and intraoperative techniques and approaches, including multidisciplinary team approaches, have been developed to optimize these surgical goals. Differences in spectrum, biology, and clinical presentation of brain tumors in the pediatric patient population demand special surgical expertise to warrant optimal postoperative patient outcome.