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Topic: Brain tumor cell invasion and metastasis: anatomical, biological and clinical considerations

Brain tumor surgery: supplemental intra-operative imaging techniques
and future challenges

Telmo Augusto Barba Belsuzarri, Raphael Martinelli Anson Sangenis, João Flavio Mattos Araujo
Department of Neurosurgery, Pontifical Catholic University of Campinas, Campinas, São Paulo 13060-803, Brazil.
Correspondence to: Dr. Telmo Augusto Barba Belsuzarri, Department of Neurosurgery, Pontifical Catholic University of Campinas, Campinas, São
Paulo 13060-803, Brazil. E-mail: telmobelsuzarri@hotmail.com

Telmo Augusto Barba Belsuzarri, MD, is a Neurosurgery Resident at the Pontifical Catholic University of Campinas
(PUC-CAMPINAS). Graduated in Neurocritical Care, with thesis in Magnesium Sulphate in Neurointensive care,
Dr. Belsuzarri has published papers in several areas and has special interest in Neurooncology/Cranial Base, Vascular
Neurosurgery and Functional Neurosurgery.

A B S T R AC T
Modern brain tumor surgery stands in the pillar of maximum safe resection. Tumor borders are always challenging, especially
infiltration zones in malignant brain tumors. Novel technologies are designed for a better delineation and to increase the extent
of resection (EOR) in brain tumor surgery, such as: cortical and sub-cortical mapping strategies with somatosensory-evoked
potentials, awake stimulation mapping and cortical/sub-cortical stimulation for motor pathways, important for resection in eloquent
areas; intra-operative imaging as functional and intra-operative magnetic resonance imaging, diffusion tensor imaging and intra-
operative ultrasound are important for the tumor borders and to achieve the gross total resection; neurochemical navigation
methods as 5-aminolevulinic and sodium fluorescein are important for the non-contrast-enhanced tumor border; future methods
can be achieved with augmented reality surgery, new intra-operative chemical markers, and visualization methods. Nevertheless
all these techniques seem to be promising, the real challenge in the future will be held in how to apply them and how they really
affect the prognosis of the patients. Also, new concepts in tumor genetics will provide knowledge for the tumor behavior and
will guide resection. Despite all limitations, the increasing importance of safe EOR shows the possible benefits of the novel
technologies and surgical advances in brain tumor surgery, taking it to a new step of the neuronavigation era.

Key words: Brain tumor; fluorescein; intra-operative; neuronavigation; novel; technology

INTRODUCTION New imaging technologies are applied to other two
different manners, pre-surgical moment and intra-operative
Neurosurgery went through several changes over the past imaging. [1]
50 years; technology has been applied to all fields, since the
introduction of microscope and the microsurgical technique Modern neurosurgery lives a paradigm of concepts.
by Yasargil, until endoscopes, minimally invasive spine Although there are insufficient proves of the real benefits
[2]
surgery and functional neurosurgery with deep brain and impacts of the aggressive image-guided neurosurgery,
evidences show the importance of gross total resection
stimulation implants. As we see, the neurosurgery has two (GTR) in the quality of treatment and the effectiveness
important arms in this modern era: the equipment and the
surgical expertise. This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as
Access this article online the author is credited and the new creations are licensed under the identical
terms.
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Website: For reprints contact: service@oaepublish.com
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How to cite this article: Belsuzarri TAB, Sangenis RMA, Araujo JFM.
Brain tumor surgery: supplemental intra-operative imaging techniques
DOI: and future challenges. J Cancer Metastasis Treat 2016;2:70-9.
10.4103/2394-4722.172249
Received: 29-09-2015; Accepted: 30-11-2015.

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©2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc.