Intraoperative imaging techniques to improve tumor detection in the surgical management of gliomas

The modern treatment of both high and low-grade glioma involves achieving a maximum resection of radiographically visible as well as occult infiltrative tissue without sacrificing neurologic function. To this end, several intraoperative imaging adjuncts have been developed including translation of traditional imaging tools such as MRI, CT scan, and ultrasonography to the operating room. Novel techniques in glioma surgery include fluorescence guided surgery which takes advantage of cellular differences to illuminate tumor tissue and allow for easier differentiation. Future intraoperative imaging techniques are focused on identifying histopathologic differences between tumor and normal brain to maximize the identification of infiltrative tissue that is otherwise not visible with existing techniques. In this chapter we will describe the advantages and disadvantages of each of these techniques and describe how each can be used in the modern neurosurgeon's armamentarium.