Surgery of supratentorial tumors

Neurosurgery may be the ultimate treatment of benign tumors, eg, certain meningiomas and acoustic neurinomas; however, for invasive and malignant tumors, it is just another part in a multimodality approach coupled with radiotherapy, chemotherapy, and possibly immunotherapy. Still heading for more efficiency, new surgical techniques and aids have been developed. Their multiplicity and precision should encourage the neurosurgeon to even more carefully plan the type of surgery by a thorough preoperative evaluation. Preoperative management now not only assesses the size and the extent of the tumor but tries to find hints of its degree of malignancy to understand the perilesional edema and to guide the surgeon's hand. Although surgical approaches have been improved over the past years by the introduction of microsurgery, the ultrasonic aspirator, laser, and perioperative ultrasound, computer-assisted stereotactic neuronavigation seems to be the major novelty, and its future developments may prove to be of great medical value. Finally, the postoperative evaluation of the patient also benefits from new standards in neuroimaging and radionuclide investigations, allowing better estimation of residual tumor and early diagnosis of recurrence.