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Bello L et al.  
Technological Advances in Glioma Surgery

European Association of NeuroOncology Magazine 2011; 1 (1): 13-19

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Operating Theatre
Figure 1a-f: Example of integration in the operating theatre of various types of imaging in a case of left temporo-insular low-grade glioma: (a) volumetric FLAIR; (b) DTI FT reconstruction of IFO (white) superimposed onto a postcontrast T1-weighted MR image; (c) spots of activation for denomination (in white) obtained with fMRI, superimposed onto FLAIR images; (d) axial and (e) coronal post-contrast-T1 weighted images, and (f) spots of activation for verbal generation (in white) obtained with fMRI, superimposed onto FLAIR images. All these images were loaded into the neuronavigation system, co-registered, and fused together to be available during surgery. Surgery was performed in awake anaesthesia and the patient was continuously submitted to object-naming tests by the neuropsychologist during resection. The green cross indicates a subcortical site where semantic paraphrasia was induced by DES, at this site corresponded to the IFO as indicated in (b) and to the medial deep border of the tumour, as shown by FLAIR images (a).

Keywords: FLAIRMRI
Figure 2a-b: Example of integration of intraoperative neurophysiology with advanced MR imaging (DTI-FT) in a case of a left rolandic tumour. In this case, at the beginning of the resection the surgeon should integrate information coming from DES cortical mapping (a) (left and middle panel showing hand motor responses from the hand obtained by train of 5 techniques [left panel]) and 60 Hz probes [middle panel]), to those obtained by DTI-FT. The right panel shows the DTI-FT reconstruction for CST (in white) superimposed onto post-contrast T1-weighted images. The green cross indicates the position of the cortex where DES found hand motor responses. The site corresponded to the CST as indicated by DTI-FT images. The same type of integration is shown during resection at the subcortical level (b). The green cross indicates the site where DES (with both train of 5 techniques and 60 Hz) located hand responses from the subcortical of the CST, which corresponded to the same position in the DTI-FT images.

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