Surgical Resection Techniques of Central Area Gliomas

The resection of eloquent located infiltrating brain tumors still presents one of the most formidable challenges in neurosurgery. The need to perform complete (and hence aggressive) resections of high-grade gliomas has been strongly supported by level II evidence of the impact of a complete resection on survival [1–3] and stands in contrast to the need to preserve the patients’ integrity and the general principle of medicine to “ first do no harm.” Fortunately, recent developments in neuro-oncologic neurosurgery provide technologies that can allow for a safe and still aggressive resection even in the central motor area. Among these developments are: Improved preoperative imaging (metabolic and functional/anatomic) that allows for improved planning, Intraoperative visualization of the tumor (5-aminolevulinic acid [ALA], ultrasound, and intraoperative magnet resonance tomography [iMRI]) The identification of functional and nonfunctional areas (i.e., resectable areas) by intraoperative monitoring.