Multimodal Imaging in Glioma Surgery

In this chapter, the authors present current possibilities of intraoperative visualization of brain gliomas. These tumors are often macroscopically similar to the normal brain but typically well visualized by magnetic resonance imaging (MRI). Therefore, neuronavigation based on preoperative MRI is often used in order to localize glioma tissue. However, the accuracy of neuronavigation is limited due to the brain shift, and after some tumor debulking, it becomes unreliable. Intraoperative imaging techniques – intraoperative MRI and intraoperative ultrasound – represent a solution to this problem as these modalities enable an update of the neuronavigation data during the surgical procedure. In malignant gliomas, utilization of fluorescent agents is another possibility of intraoperative tumor tissue visualization. Benefits and pitfalls of aforementioned methods are discussed, with special emphasis on intraoperative ultrasound