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Vol. 31. Issue 4.
Pages 184-194 (July - August 2020)
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Vol. 31. Issue 4.
Pages 184-194 (July - August 2020)
Review article
Intraoperative imaging in the neurosurgery operating theatre: A review of the most commonly used techniques for brain tumour surgery
Imagen intraoperatoria en el quirófano de neurocirugía: revisión de las técnicas más empleadas para la cirugía de los tumores cerebrales
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Sonia Tejada Solísa,
Corresponding author
stejadasolis@yahoo.es

Corresponding author.
, Cristian de Quintana Schmidtb, Josep Gonzalez Sánchezc, Ignacio Fernández Portalesd, Marta del Álamo de Pedroe, Victor Rodríguez Berrocale, Ricardo Díez Vallea, Grupo de trabajo de la SENEC
a Departamento de Neurocirugía, Clínica Universidad de Navarra, Pamplona, Spain
b Departamento de Neurocirugía, Hospital San Pau i Creu, Barcelona, Spain
c Departamento de Neurocirugía, Hospital Clínic y provincial de Barcelona, Barcelona, Spain
d Departamento de Neurocirugía, Hospital Infanta Cristina, Badajoz, Spain
e Departamento de Neurocirugía, Hospital Ramón y Cajal, Madrid, Spain
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Table 1. Summary of the advantages and disadvantages of the intraoperative imaging techniques.
Abstract
Introduction

New intraoperative imaging techniques, which aim to improve tumour resection, have been implemented in recent years in brain tumour surgery, although they lead to an increase in resources. In order to carry out an update on this topic, this manuscript has been drafted by a group from the Sociedad Española de Neurocirugía [Spanish Society of Neurosurgery].

Material and Methods

Experts in the use of each one of the most-used intraoperative techniques in brain tumour surgery were presented with a description of the technique and a brief review of the literature. Indications for use, their advantages and disadvantages based on clinical experience and on what is published in the literature will be described.

Results

The most robust intraoperative imaging technique appears to be low- and high-field magnetic resonance imaging, but this is the technique which results in the greatest expenditure. Intraoperative ultrasound navigation is portable and less expensive, but it provides poorer differentiation of high-grade tumours and is observer-dependent. The most-used fluorescence techniques are 5-aminolevulinic acid for high-grade gliomas and fluorescein, useful in lesions which rupture the blood-brain barrier. Last of all, intraoperative CT is more versatile in the neurosurgery operating theatre, but it has fewer indications in neuro-oncology surgery.

Conclusions

Intraoperative imaging techniques are used with increasingly greater frequency in brain tumour surgery, and the neurosurgeon should assess their possible use depending on their resources and the needs of each patient.

Keywords:
Intraoperative imaging
Surgery
Brain tumours
Neurosurgery
Resumen
Introducción

La cirugía de los tumores cerebrales se ha implementado en los últimos años con nuevas técnicas de imagen intraoperatoria, que tratan de mejorar la resección tumoral, aunque conllevan un aumento de recursos. Con el fin de hacer una actualización de este tema, se ha elaborado este manuscrito desde el grupo de tumores de la sociedad española de neurocirugía.

Material y Metodos

Se ha propuesto a expertos en el uso de cada una de las técnicas intraoperatorias más empleadas en la cirugía de los tumores cerebrales, la descripción de la técnica y una breve revisión de la literatura. Se describirán indicaciones de uso, sus ventajas e inconvenientes basados en la experiencia clínica y en lo publicado en la literatura.

Resultados

La técnica de imagen intraoperatoria más robusta sería la resonancia de bajo y alto campo, pero a su vez es la que supone un mayor gasto de recursos. La ecografía intraoperatoria navegada es portátil y tiene un menor coste, aunque discrimina peor los tumores de alto grado y es observador dependiente. Las técnicas de fluorescencia más empleadas son el 5-aminolevulínico para gliomas de alto grado y la fluoresceína, de utilidad en lesiones que rompen la barrera hematoencefálica. Por último, el TAC intraoperatorio es el más versátil en el quirófano de neurocirugía, pero tiene menos indicaciones en la cirugía neurooncológica.

Conclusiones

Las técnicas de imagen intraoperatoria se emplean cada vez con más frecuencia en la cirugía de los tumores cerebrales, y el neurocirujano debe valorar su posible uso en función de sus recursos y las necesidades de cada paciente.

Palabras clave:
Imagen intraoperatoria
Cirugía
Tumores cerebrales
Neurocirugía

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