Abstract:
The definition of complete resection in neurosurgery depends on tumor type, surgical aims, and postoperative investigations, directly guiding the choice of intraoperative tools. Most common tumor types present challenges in achieving complete resection due to their infiltrative nature and anatomical constraints. The development of adjuvant treatments has altered the balance between oncological aims and surgical risks. We review local recurrence associated with incomplete resection based on different definitions and emphasize the importance of achieving maximal safe resection in all tumor types. Intraoperative techniques that aid surgeons in identifying tumor boundaries are used in practice and in preclinical or clinical research settings. They encompass both conservative and invasive techniques. Among them, morphological tools include imaging modalities such as intraoperative magnetic resonance imaging, ultrasound, and optical coherence tomography. Fluorescence-guided surgery, mainly using 5-aminolevulinic acid, enhances gross total resection in glioblastomas. Nuclear methods, including positron emission tomography probes, provide tumor detection based on beta or gamma emission after a radiotracer injection. Mass spectrometry- and spectroscopy-based methods offer molecular insights. The adoption of these techniques depends on their relevance, effectiveness, and feasibility. With the emergence of positron emission tomography imaging for use in recurrence benchmarking, positron emission tomography probes raise particular interest among those tools. While all such tools provide valuable insights, their clinical benefits need further evaluation.
摘要:
背景:神经外科完全切除的定义取决于肿瘤类型,手术目标,和术后调查,直接指导术中工具的选择。
方法:由于浸润性和解剖学限制,大多数常见的肿瘤类型在实现完全切除方面存在挑战。辅助治疗的发展改变了肿瘤目标和手术风险之间的平衡。我们根据不同的定义回顾了与不完全切除相关的局部复发,并强调了在所有肿瘤类型中实现最大安全切除的重要性。在实践中以及临床前或临床研究环境中使用了帮助外科医生识别肿瘤边界的术中技术。它们包括保守和侵入性技术。其中,形态学工具包括成像模式,如术中MRI,超声,和光学相干层析成像。荧光引导手术,主要使用5-氨基乙酰丙酸,增强胶质母细胞瘤的总切除。核方法,包括PET探针,根据放射性示踪剂注射后的β或γ发射提供肿瘤检测。质谱和基于光谱学的方法提供了分子见解。
结论:这些技术的采用取决于它们的相关性,有效性,和可行性。随着PET成像作为复发基准的出现,PET探针在这些工具中引起了特别的兴趣。虽然它们都提供了有价值的见解,其临床获益需要进一步评估.