Information-guided Surgery for Glioma Removal

Abstract

The relationship between radical resection of glioma and patient outcomes has been controversial, partly because of selection bias, publication bias, and methodological flaws, particularly in regard to the estimation of the glioma removal rate. A recent study used volumetric analysis of removal rate to demonstrate that radical removal resulting in better patient outcomes. However, new removal strategies to maximize removal rate and minimize complication rates are needed to further improve outcomes. The goal of the present study was to develop an algorithm for "information-guided surgery", in which surgeons rely on objective information rather than subjective experience to determine whether glioma removal is feasible. An operating system (intelligent operating theater) was developed that detects anatomical, functional, and histological information obtained by intraoperative magnetic resonance images/navigation, mapping/monitoring data, and data from frozen section, evaluate the validity of the data, and subsequently integrates the data with update navigation. The present study focused on the benefits and drawbacks of functional information and introduces illustrative cases of information-guided surgery.