Intraoperative glioblastoma surgery-current challenges and clinical trials: An update

Abstract

Surgical excision is an important part of the multimodal therapy strategy for patients with glioblastoma, a very aggressive and invasive brain tumor. While major advances in surgical methods and technology have been accomplished, numerous hurdles remain in the field of glioblastoma surgery. The purpose of this literature review is to offer a thorough overview of the current challenges in glioblastoma surgery. We reviewed the difficulties associated with tumor identification and visualization, resection extent, neurological function preservation, tumor margin evaluation, and inclusion of sophisticated imaging and navigation technology. Understanding and resolving these challenges is critical in order to improve surgical results and, ultimately, patient survival.

Keywords: Awake craniotomy; Evoked potentials; Glioblastoma; Infiltrative tumor; Navigation; Neuroimaging.

Graphical abstract

Figure 1

Demarcation of the infiltrative tumor using various intraoperative imaging techniques. (A) iMRI; (B) iUS; (C) F-5 ALA. F-5 ALA: Fluorescence-guided surgery with 5-aminolevulinic acid; iMRI: Intraoperative magnetic resonance imaging; iUS: Intraoperative ultrasound.

Figure 2

Intraoperative mapping of eloquent brain regions using different methods. (A) Awake craniotomy; (B) Direct electrical stimulation; (C) Diffusion tensor imaging.

Figure 3

Detection of neurocognitive dysfunctions during glioma surgery using two ways: (A) Motor-evoked potentials; (B) Somatosensory-evoked potentials. D: Direct wave; I: Indirect wave.