Neurosurgical intervention is essential for the safe and effective management of adult gliomas. Increasing evidence suggesting that for both low- and high-grade gliomas, maximal cytoreduction is associated with an increased overall survival. Beyond conventional neurosurgical principles, there are a variety of techniques that have been refined over the last decade to maximise the efficiency of the neurosurgeon and post-operative management. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) are two non-invasive techniques used to localise eloquent motor and language anatomy and higher cognitive pathways to inform decision-making and preoperative surgical planning. Novel intraoperative techniques include neuronavigation, cortical and subcortical mapping, high-frequency ultrasonography, Raman spectroscopy, fluorescence-guided surgery and locally delivered therapies such as carmustine. These therapies are valuable tools which act to reduce post-operative neurological deficits therefore reducing the overall tumour burden on the patient by improving quality of life. Operating on elderly patients with gliomas, as well as those with recurrent disease, is still controversial but is becoming more common due to advances in adjunct technologies. In summary this collection of management strategies has aided the neurosurgeon in achieving optimal surgical cytoreduction in the management of adult glioma.
KeywordsSurgery Glioma High-grade glioma (HGG) Neuronavigation Direct cortical stimulation Intraoperative magnetic resonance imaging (iMRI) Functional MRI (fMRI) Extent of resection Overall survival Progression-free survival
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