Surgical Adjuncts to Increase the Extent of Resection: Intraoperative MRI, Fluorescence, and Raman Histology

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Todd Hollon1, Walter Stummer2, Daniel Orringer1

  • 1Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.

Neurosurgery Clinics of North America
|November 25, 2018
PubMed

Insights

Accurately identifying low-grade glioma tumor margins during surgery is difficult. This review analyzes advanced tools like 5-aminolevulinic acid fluorescence and Raman histology to improve surgical decision-making and tumor detection.

Area of Science:

  • Neurosurgery
  • Oncology
  • Medical Imaging

Background:

  • Accurate delineation of tumor margins in low-grade glioma surgery is a significant challenge.
  • Several advanced tools are being developed to aid surgeons in real-time decision-making during glioma resection.

Purpose of the Study:

  • To analyze and discuss emerging surgical adjuncts for low-grade glioma surgery.
  • To evaluate the utility of intraoperative MRI, 5-aminolevulinic acid (5-ALA) fluorescence, and Raman histology in improving tumor margin depiction and tissue diagnosis.

Main Methods:

  • Review and analysis of existing literature on surgical adjuncts for low-grade glioma.
  • Discussion of the principles, advantages, and limitations of intraoperative MRI, 5-ALA fluorescence, and Raman histology.

Main Results:

  • Intraoperative MRI provides valuable information but is costly and time-consuming.
  • 5-ALA fluorescence offers real-time guidance, is independent of brain shift, and aids in detecting malignant tissue and anaplastic foci.
  • Raman histology shows potential for in vivo tumor detection and identifying tumor infiltration in biopsied tissue.

Conclusions:

  • Advanced tools like 5-ALA fluorescence and Raman histology show promise in overcoming the challenges of tumor margin delineation in low-grade gliomas.
  • These adjuncts can potentially improve surgical outcomes by enabling more precise tumor resection and diagnosis.
Keywords:
5-Aminolevulnic acidFluorescence-guided resectionsIntraoperative MRILow-grade gliomaRaman spectroscopyStimulated Raman histology

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