Intraoperative image-guided surgery in neuro-oncology with specific focus on high-grade gliomas

Surgery is paramount in glioma management and extent of resection is an independent significant prognostic factor. However, these tumors are often invisible intraoperatively. Hence imaging plays an important role in surgical guidance. A critical literature review, using MEDLINE/PubMed service was carried out. It demonstrated a gross total resection (GTR) with neuronavigation (NNS) of 31-36%, adding 5-aminolevulinic acid or fluorescein fluorescence, or intraoperative ultrasound or MRI improved GTR to 69.1, 84.4, 73.4 and 70% respectively. The differences between the four intraoperative technologies were not statistically significant. Therefore, NNS provided a platform for planning surgical approaches and localization of lesions, however significant brain shift rendered NNS useless without the addition of intraoperative imaging, of which 5-aminolevulinic acid, fluorescein, intraoperative ultrasound and intraoperative MRI significantly improved GTR and outcome of glioma surgery.