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Ianastasija Omoore
Ianastasija Omoore

Atlas Of Operative Microneurosurgery, Vol. 2: Brain Tumors [UPD]

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Atlas Of Operative Microneurosurgery, Vol. 2: Brain Tumors [UPD]

In the relatively new field of microneurosurgery, the development and use of the transcisternal, transfissural, and transsulcal approaches80,84,85 have established the sulci as fundamental landmarks on the brain surface. The well-known variability in cortical function1,2,17,47,53,75 calls for the aid of cortical mapping techniques to precisely identify specific sites related to cortical function. Nevertheless, detailed knowledge of the structure and form of the cerebral sulci and gyri continues to be mandatory for neuroimaging as well as intraoperative guidance. Once identified, the cerebral sulci can be used by the neurosurgeon either as microneurosurgical corridors or simply as cortical landmarks.61,62

Abstract: Breast cancer is the most common malignancy among women worldwide, and the main cause of death in patients with breast cancer is metastasis. Metastasis to the central nervous system occurs in 10% to 16% of patients with metastatic breast cancer, and this rate has increased because of recent advancements in systemic chemotherapy. Because of the various treatments available for brain metastasis, accurate diagnosis and evaluation for treatment are important. Magnetic resonance imaging (MRI) is one of the most reliable preoperative examinations not only for diagnosis of metastatic brain tumors but also for estimation of the molecular characteristics of the tumor based on radiographic information such as the number of lesions, solid or ring enhancement, and cyst formation. Surgical resection continues to play an important role in patients with a limited number of brain metastases and a relatively good performance status. A single brain metastasis is a good indication for surgical treatment followed by radiation therapy to obtain longer survival. Surgical removal is also considered for two or more lesions if neurological symptoms are caused by brain lesions of >3 cm with a mass effect or associated hydrocephalus. Although maximal safe resection with minimal morbidity is ideal in the surgical treatment of brain tumors, supramarginal resection can be achieved in select cases. With respect to the resection technique, en bloc resection is generally recommended to avoid leptomeningeal dissemination induced by piecemeal resection. An operating microscope, neuronavigation, and intraoperative neurophysiological monitoring are essential in modern neurosurgical procedures, including tumor resection. More recently, supporting surgical instruments have been introduced. The use of endoscopic surgery has dramatically increased, especially for intraventricular lesions and in transsphenoidal surgery. An exoscope helps neurosurgeons to comfortably operate regardless of patient positioning or anatomy. A tubular retractor can prevent damage to the surrounding brain tissue during surgery and is a useful instrument in combination with both an endoscope and exoscope. Additionally, 5-aminolevulinic acid (5-ALA) is a promising reagent for photodynamic detection of residual tumor tissue. In the near future, novel treatment options such as high-intensity focused ultrasound (HIFU), laser interstitial thermal therapy (LITT), oncolytic virus therapy, and gene therapy will be introduced.

Complete removal of metastatic brain tumors, termed gross total resection (GTR), is the ideal goal in surgical treatment. According to the latest guidelines published by the Congress of Neurological Surgeons, GTR is recommended over subtotal resection to improve overall survival and prolong the time to recurrence (23). However, recurrence affects about 20% of patients even after treatment with GTR followed by SRS (29). In contrast to diffusely invading tumors such as gliomas, metastatic brain tumors are more often well demarcated masses surrounded by gliotic tissue (26). Several reports have shown that supramarginal resection achieved by additional 5-mm surrounding tissue resection fr


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