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Furthermore, these biomarkers could also been applied for   interface has come tighter and promising. However, the best
            other tumors and even other neurological diseases, without   result will come with the integration between technology
            any contrast addition and increase of costs. [69,70]  for resection and tumor nature knowledge.

            For high-grade lesions with increased neo-vascularization,   Financial support and sponsorship
            there was a report with use of indocyanine  green (ICG)   Nil.
            for detection  of tumor  borders. It  is classically  used by
            ophthalmologists for retinal vasculature and more recently   Conflicts of interest
            for  vascular  neurosurgeries  for  aneurysms  and  arterio-  There are no conflicts of interest.
            venous  malformations;  however,  for  surgical  borders  for
            high-grade gliomas, it is a novel technique.  Eyüpoglu et   REFERENCES
                                               [71]
            al. reported the ability of demonstrating the hypervascular
            areas with ICG that were not visible with the 5-ALA use.   1.   D’amico  RS,  Kennedy  BC,  Bruce  JN.  Neurosurgical  oncology:
            This technique was called dual intra-operative visualization   advances  in  operative  technologies  and  adjuncts.  J  Neurooncol
            approach (DIVA) with the initial approach using 5-ALA;   2014;119:451-63.
            after all initial tumor was resected, ICG was administered   2.   Barone  DG, Lawrie  TA, Hart  MG. Image  guided  surgery  for  the
            for visualization of remaining hypervascularization areas,   resection of brain tumours. Cochrane Database Syst Rev 2014; doi:
                                                                  10.1002/14651858.
            with  good  initial  results.  Further  studies  are  needed,  but   3.   Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte
            DIVA technique could be an interesting approach for further   F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K,
            resection of non-fluorescein areas. [72]               Michael  C,  Miller  D,  Sawaya  R.. A  multivariate  analysis  of  416
                                                                  patients with glioblastoma multiforme: prognosis, extent of resection,
            One  of  the  most  difficult  tasks  in  glioma  surgery  is  the   and survival. J Neurosurg 2001; 95:190-8.
            low-grade  lesion.  Most  of  the  low-grades  have  similar   4.   Sanai  N,  Polley  MY,  McDermott  MW,  Parsa AT,  Berger  MS. An
            density, echogenicity, and macroscopic aspect. Despite the   extent of resection threshold for newly diagnosed glioblastomas. J
            neuronavigation progression, there are few MRI methods   5.   Neurosurg 2011;115:3-8.
                                                                  Sanai N, Berger MS. Glioma extent of resection and its impact on
            for low-grade tumor visualization, and most of the times the   patient outcome. Neurosurgery 2008;62:753-64; discussion 264-6.
            lesion is not contrast-enhanced and there is just the FLAIR   6.   Vigneswaran  K,  Neill  S,  Hadjipanayis  CG.  Beyond  the  World
            sequence for tumor borders.  Ramakrishna et al. showed   Health  Organization  grading  of  infiltrating  gliomas:  advances  in
                                   [73]
            improvement of overall survival with aggressive resection   the  molecular  genetics  of  glioma  classification.  Ann  Transl  Med
            of FLAIR tumor limits, not only in the first attempt, but   2015;3:95.
            also in reoperation, regardless of patient  age, pathology,   7.   Rudà R, Pellerino A, Magistrello M, Franchino F, Pinessi L, Soffietti
            chemotherapy, and radiation. [74]                     R. Molecularly Based Management of gliomas in clinical practice.
                                                                  Neurol Sci 2015;36:1551-7.
                                                               8.   Eckel-Passow JE, Lachance DH, Molinaro AM, Walsh KM, Decker
            The 5-ALA for LGGs is usually reported as non-visible, but   PA, Sicotte H, Pekmezci M, Rice T, Kosel ML, Smirnov IV, Sarkar G,
            it is not true for all of them. Valdés showed that 5/12 patients   Caron AA, Kollmeyer TM,Praska CE, Chada AR, Halder C, Hansen
            had at least 1 instance of visible fluorescence during surgery   HM,  McCoy  LS,  Bracci  PM,  Marshall  R,  Zheng  S,  Reis  GF,  Pico
            and 45% of the non-visible fluorescence had a higher and   AR, O’Neill BP, Buckner JC, Giannini C, Huse JT,Perry A, Tihan T,
            detectable concentration of PpIX in the tumor tissue after   Berger MS, Chang SM, Prados MD, Wiemels J, Wiencke JK, Wrensch
            the 5-ALA administration. With this idea, other researches   MR, Jenkins RB. Glioma Groups Based on 1p/19q, IDH and TERT
            were  made  to  accurate  the  visibility  of  the  fluorescein,   9.   Promoter Mutations in Tumors. N Engl Med 2015;372:2499-508.
                                                                  Fontana EJ, Benzinger T, Cobbs C, Henson J, Fouke SJ. The evolving
            or guide the elevated concentration in tissue with special   role of neurological imaging  in neuro-oncology.  J  Neurooncol
            probes of light visualization or high-resolution microscopic   2014;119:491-502.
            techniques, but with few results by this date. [75]  10.  Johnson RD, Stacey RJ. The impact of new imaging technologies in
                                                                  neurosurgery. Surgeon 2008; 6:344-9.
            CONCLUSION                                         11.  Grossman SA Ye X, Piantadosi S, Desideri S, Nabors LB, Rosenfeld
                                                                  M, Fisher J. Survival of patients with newly diagnosed glioblastoma
                                                                  treated with radiation and temozolomide in research studies in the
            Evidences  of  the  correlation  between  tumor  removal   United States. Clinical Cancer Res 2010;16:2443-9.
            and  increase  of  survival  rate  have  an  impulse  in  novel   12.  Stupp R, Tonn JC, Brada M, Pentheroudakis G. ESMO Guidelines
            technologies for safe resection and EOR. The uses of iMRI,   Working  Group.High-grade  malignant  glioma:  ESMO  Clinical
            DTI, PET, iUS, and fluorescence guidance have come to   Practice  Guidelines  for diagnosis, treatment  and follow-up.  Ann
            establish the neuronavigation era in neurosurgery.    Oncol 2010;21 Suppl 5:v190-3.
                                                               13.  Stupp R, Hegi M, Weller. Neuro-oncology, a decade of temozolomide
                                                                  and beyond. Expert Rev Anticancer Ther 2010;1675-7.
            Also, there is an increasing  importance of the tumor genetics   14.  Dandy WE. Removal of right cerebral hemisphere for certain tumors
            and behavior, which will provide crucial information and   with hemiplegia: Preliminary report. JAMA 1928; 90:823-5.
            will guide tumor resection and adjuvant treatment. Despite   15.  Dandy WE. Physiological studies following extirpation of the right
            all  limitations  of  each  technology  and  the  lack  of  clear   cerebral hemisphere in man. Bull Johns Hopkins Hosp 1933;53:31-51.
            evidences,  it  is  clear  that  this  neurosurgeon/technology   16.  Talacchi A,  Santini  B,  Casagrande  F, Alessandrini  F,  Zoccatelli  G,


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