Open AccessStructural and Functional Imaging in Glioma Management
Author(s) -
Bledi Brahimaj,
Ryan B. Kochanski,
John J. Pearce,
Melike Güryildirim,
Carter S. Gerard,
Mehmet Koçak,
Sepehr Sani,
Richard W. Byrne
Publication year - 2020
Publication title -
neurosurgery/neurosurgery online
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.485
H-Index - 34
eISSN - 1081-1281
pISSN - 0148-396X
DOI - 10.1093/neuros/nyaa360
Subject(s) - medicine , glioma , modalities , magnetic resonance imaging , magnetoencephalography , diffusion mri , white matter , radiology , lesion , transcranial magnetic stimulation , functional imaging , neuronavigation , neuroscience , pathology , electroencephalography , stimulation , psychology , social science , cancer research , psychiatry , sociology
The goal of glioma surgery is maximal safe resection in order to provide optimal tumor control and survival benefit to the patient. There are multiple imaging modalities beyond traditional contrast-enhanced magnetic resonance imaging (MRI) that have been incorporated into the preoperative workup of patients presenting with gliomas. The aim of these imaging modalities is to identify cortical and subcortical areas of eloquence, and their relationship to the lesion. In this article, multiple modalities are described with an emphasis on the underlying technology, clinical utilization, advantages, and disadvantages of each. functional MRI and its role in identifying hemispheric dominance and areas of language and motor are discussed. The nuances of magnetoencephalography and transcranial magnetic stimulation in localization of eloquent cortex are examined, as well as the role of diffusion tensor imaging in defining normal white matter tracts in glioma surgery. Lastly, we highlight the role of stimulated Raman spectroscopy in intraoperative histopathological diagnosis of tissue to guide tumor resection. Tumors may shift the normal arrangement of functional anatomy in the brain; thus, utilization of multiple modalities may be helpful in operative planning and patient counseling for successful surgery.