Brain tumor resection

• Transient Response to Liberation Maneuvers in Central Positional Nystagmus Due to Cerebral Metastases Mimicking Benign Paroxysmal Positional Vertigo- A Case Report
• Identifying proximity to white matter language tracts with gradient-based intraoperative electrical mapping
• A rare case report of insular metastatic from sarcoma with successful long term surgical and oncological management
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• Evaluating treatment outcome of Glioblastoma with Stupp's regimen: an experienced in single Institute
• Butterfly glioblastoma: trends in therapeutic modalities, extent of resection and survival in the temozolomide era. a SEER-based study
• Locating eloquent sites identified during brain tumor intraoperative mapping on reference MRI atlas

Surgical resection is indicated for:

• Diagnostic confirmation (histology, molecular profiling)
• Tumor debulking to relieve mass effect
• Gross total resection in high- or low-grade tumors
• Symptom control (e.g., seizures, focal deficits)
• Cases where radiotherapy/chemotherapy are insufficient or delayed

• MRI with contrast – to assess tumor margins, edema, and vascularity
• Functional MRI / DTI – map eloquent cortex and white matter tracts
• Neuropsychological assessment – when operating near language or motor areas
• Multidisciplinary tumor board discussion
• Steroids to reduce peritumoral edema
• Antiepileptics in selected patients

• Position depends on tumor location (e.g., supine, lateral, sitting)
• Head fixation with Mayfield clamp
• Neuronavigation setup with MRI or CT fusion

• Craniotomy tailored to lesion
• Exposure through safe entry points (e.g., sulci, non-eloquent gyri)
• Use of intraoperative ultrasound or fluorescence guidance (5-ALA) as needed

• En bloc resection for well-circumscribed tumors
• Piecemeal resection for infiltrative or deep lesions
• Use of ultrasonic aspirator, microscissors, and bipolar coagulation
• Resection guided by:
  • Neuronavigation
  • Intraoperative MRI
  • Awake mapping (for tumors near language or motor areas)
  • Fluorescence (e.g., 5-ALA or fluorescein)

• Meticulous coagulation to prevent postoperative hematoma
• Dura closure (watertight if possible)
• Bone flap replacement or cranioplasty as needed

• MRI within 48 hours to assess extent of resection
• Monitor for:
  • Hemorrhage
  • Seizures
  • Neurological worsening
  • CSF leak or infection
• Resume steroids taper
• Pathology → determines further treatment (radiotherapy, chemotherapy)
• Early rehab if neurological deficits occur

• Intracranial hemorrhage
• Infection (meningitis, abscess)
• Seizures
• Hydrocephalus
• Neurological deficits (motor, language, vision)

Brain tumor resection is a cornerstone of neuro-oncology. Goals include:

• Maximal safe resection
• Preservation of neurological function
• Enabling accurate diagnosis and adjuvant therapy planning

Success relies on imaging guidance, neuromonitoring, and multidisciplinary coordination.

Optimal resection of tumors in eloquent locations requires a combination of intraoperative imaging and functional monitoring during surgery.

Primary resection

Microsurgical resection

Incomplete resection is a risk factor for decreased survival in gliomas.

See Extent of resection

Before the general use of post-operative scanning, intraoperative estimation by the neurosurgeon was used to determine partial resection, subtotal resection, or total resection. The only study that compared this estimation with the presence of residual tumor mass on an MR image, dates back to 1994 ¹⁾.

see Kobayashi tumor removal grading system.

5-aminolevulinic acid (5-ALA) fluorescence-guided resection is a technique used in neurosurgery, particularly for brain tumor resection, including metastases. This method involves the administration of 5-ALA to the patient before surgery, which is then metabolized by the tumor cells to produce fluorescent porphyrins. The fluorescence emitted by these porphyrins can be visualized using special surgical microscopes equipped with a blue light source, allowing neurosurgeons to distinguish between normal and cancerous tissue during the operation.