Implementation of Neuronavigation-Guided Resection in Complex Intracranial Tumors

The chapter presents cutting-edge surgical advances, neuronavigation, intraoperative MRI (iMRI), and 5-aminolevulinic acid (5-ALA) fluorescence-guided resection techniques for treating complex intracranial tumors and their implications for clinical care. These advances allow the surgeon to visualize the tumor in real time and know where the tumor begins and ends—all of which improve surgical accuracy, decrease complications and increase extents of resection (EOR). Neuronavigation, often described as a “GPS for the brain,” uses data from multiple imaging modalities (CT, MRI, and functional studies) to develop an intraoperative 3D map of the intraoperative anatomy. This increases surgical finesse, reduces the injury to normal brain, and promotes more aggressive tumor resection. The development of neuronavigation has changed from the initial stereotactic frame, to incorporating a frameless intraoperative mapping approach to now being image-integrated (providing dynamic image updates)—and provides an important opportunity to improve surgical precision.