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Intraoperative imaging in the management of brain tumors: A review of contemporary adjuncts used in routine practice

Optimizing the extent of resection remains a primary goal of surgery for diffuse gliomas and most brain tumors. Limitations of capabilities of human visualization necessitate the use of adjuncts to augment and improve outcomes. This review serves to encapsulate the commonly used adjuncts in neurosurgical oncology. There exists a plethora of such techniques which can broadly be divided into image-guided techniques (including navigation and real-time intraoperative imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging) as well as optical imaging techniques (of which fluorescence is the most widely used one). This review describes these techniques briefly and reviews pertinent literature focusing on the utility and benefits of these modalities. Both diagnostic accuracy and the therapeutic outcomes are discussed. Although each modality is supported by published literature, the quality of the evidence is variable. It is difficult to make comparisons across studies due to variability in study design, populations included, and the techniques used for the assessment of outcomes. It is likely that a combination of modalities will be synergistic and judicious use of the range of adjuncts is advisable.