Articles: neuronavigation.
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Neurosurgical intervention remains the first step in effective glioma management. Mounting evidence suggests that cytoreduction for low- and high-grade gliomas is associated with a survival benefit. ⋯ Other adjunct techniques, such as intraoperative magnetic resonance imaging, intraoperative ultrasonography, and fluorescence-guided surgery, can be valuable tools to safely reduce the tumor burden of low- and high-grade gliomas. Taken together, this collection of surgical strategies has pushed glioma extent of resection towards the level of cellular resolution.
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The current neurosurgical goal for patients with malignant gliomas is maximal safe resection of the contrast-enhancing tumor. However, a complete resection of the contrast-enhancing tumor is achieved only in a minority of patients. One reason for this limitation is the difficulty in distinguishing viable tumor from normal adjacent brain during surgery at the tumor margin using conventional white-light microscopy. ⋯ Consequently, 5-ALA FGS has become an indispensable surgical technique and standard of care at many neurosurgical departments around the world. We conducted an extensive literature review concerning the surgical benefit of using 5-ALA for FGS of malignant gliomas. According to the literature, there are a number of reasons for the neurosurgeon to perform 5-ALA FGS, which will be discussed in detail in the current review.
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Review Meta Analysis
Image Guidance in Ventricular Cerebrospinal Fluid Shunt Catheter Placement: A Systematic Review and Meta-Analysis.
Ventricular shunt placement for treating hydrocephalus is one of the most common neurosurgical procedures. The rate of shunt failure, however, has not appreciably changed with time. ⋯ Although image guidance offers a promising solution to lower the risk of inaccurate catheter placement, which could lead to lower premature failure of ventricular shunts, our review demonstrated that there is not yet a clear benefit of these technologies. Current literature is limited to case series and cohort studies, and significant between-study heterogeneity in methodology and reporting currently limits a higher order analysis.
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Curr Neurol Neurosci Rep · Jan 2015
ReviewThe value of extent of resection of glioblastomas: clinical evidence and current approach.
Glioblastomas (GBM), one of the most common tumors of the central nervous system, are associated with poor prognosis, even with all the scientific development of the last decades. Individual survival, however, is not homogenous among GBM patients, and multiple factors are related to their outcome, including age, biological characteristics of the tumor, and extent of treatment. ⋯ To reach this objective, different technologies and surgical techniques have been introduced in neuro-oncology surgery, including functional neuronavigation systems, ultrasound surgery, intraoperative MRI scan, and intraoperative cortical and subcortical mapping techniques. In the current manuscript, we examine the impact of EOR on the prognosis of GBM patients and the benefits and limitations of modern adjuvant techniques used for resection of these lesions.