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Intraoperative technologies in high grade glioma surgery: strategic implementation for Asia-Pacific centers
Kathleen Joy O Khu1, Juan Silvestre G Pascual1, Abigail Javier-Lizan2
1Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
Background:
Intraoperative technologies are used in the surgical management of high grade glioma (HGG) to improve extent of resection and minimize neurologic deficits. We aim to determine the available intraoperative adjuncts for HGG surgery in Asia-Pacific centers, and propose a framework for phased implementation within the region.
Methods:
A systematic review of the literature evaluating the use of intraoperative adjuncts in HGG surgery in Asia-Pacific centers was done using PubMed/MEDLINE, Scopus, and Google Scholar databases. A website-based survey that included the top 5-10 hospital websites in each country was also performed to supplement the review. Lastly, a focus group discussion was conducted among local fellowship-trained neurosurgical oncologists to determine which intraoperative adjuncts were considered essential versus optional in HGG surgery.
Results:
Our literature review showed that intraoperative technologies may be beneficial in HGG surgery, but the existing evidence was limited to a few countries and dominated by retrospective studies. Our website review demonstrated a wide variation in the reported availability and use of intraoperative adjuncts in HGG surgery. Based on evidence and expert consensus, neuronavigation and awake craniotomy with brain mapping may represent essential adjuncts, while intraoperative MRI and fluorescence-guided surgery were considered optional. Intraoperative ultrasound and sodium fluorescein may serve as cost-effective alternatives to intraoperative MRI and 5-ALA, respectively.
Conclusion:
The availability and utilization of intraoperative adjuncts for HGG surgery across the Asia-Pacific region remain highly variable. A resource-stratified phased implementation model may provide a pragmatic framework for improving equity, safety, and quality of HGG care in resource-limited settings.
