Intraoperative Imaging for High-Grade Glioma Surgery

Abstract

This article discusses intraoperative imaging techniques used during high-grade glioma surgery. Gliomas can be difficult to differentiate from surrounding tissue during surgery. Intraoperative imaging helps to alleviate problems encountered during glioma surgery, such as brain shift and residual tumor. There are a variety of modalities available all of which aim to give the surgeon more information, address brain shift, identify residual tumor, and increase the extent of surgical resection. The article starts with a brief introduction followed by a review of with the latest advances in intraoperative ultrasound, intraoperative MRI, and intraoperative computed tomography.

Keywords: Glioblastoma; High-grade glioma; Intraoperative CT; Intraoperative MRI; Intraoperative imaging.

Fig. 1.

Navigated iUS fused to a preoperative T1-weighted MRI image of a glioma. Navigated iUS allows for accommodation of brain shift showing shift of the hyperechoic tumor relative to the registered preoperative MRI.

Fig. 2.

The AMIGO suite for image-guided surgery at Brigham and Women’s Hospital.

Fig. 3.

Preoperative contrast-enhanced T1-weighted MRI of a recurrent GBM (left), intraoperative contrast-enhanced T1-weighted MRI showing residual tumor under the lip of the resection edge (middle), postoperative T1-weighted contrasted MRI showing gross total resection of enhancing tumor (right).

Fig. 4.

(A) Magnetic resonance thermometry allows the operator to assess relative temperature maps in real-time. The three panels are the same slice taken at different time points in the ablation. (Left) The tumor (pink outline) preablation with a cooler center (bluish hue) as cooled CO₂ is sent around the catheter tip. (Middle) The same slice midablation with a relative warming up of the center of the catheter (greenish hue) and the beginnings of the thermal damage estimate beginning to appear (yellow). (Right) Further warming (reddish hue) and larger thermal damage estimate. (B) LITT ablation procedure performed in iMRI using magnetic resonance thermometry sequences to derive thermal damage estimates.