Surgery of Malignant Gliomas Using Modern Technology

Recent evidence has demonstrated that the extent of surgical resection (EOR) is an important prognostic factor in patients with malignant gliomas. However, the infiltrative growth pattern and the functional anatomy of the brain consisting of eloquent cortical and subcortical structures pose a significant limitation to the surgical resection of these tumours. The gain of knowledge regarding function, biology, and pathophysiology of the brain has resulted in the advent of advanced technology to the neurosurgeon, allowing maximal resection with minimal operative morbidity. We have reviewed the current literature concerning intraoperative imaging, fluorescence- guided resection, and awake craniotomy to generate a comprehensive overview of the most recent developments in this field. In addition, we have provided data from our own institution confirming the beneficial effects of this multimodal approach.