Brain tumors by Richard A Prayson; Mark L Cohen; Bette

By Richard A Prayson; Mark L Cohen; Bette Kleinschmidt-DeMasters

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This is particularly true for oligodendrogliomas. The use of stereotaxis or intraoperative imaging can be essential for identifying the surgical margins. Surgical Morbidity The risk of neurological injury is primarily the result of tumor location including proximity to critical cortical areas, vascular and white matter Principles of Neurosurgical Therapy 9 Figure 6 Intraoperative view of removal of a high-grade glioma. This image is projected onto several video monitors so the staff and students can follow the progress of the surgery.

This technology has moved into the operating room (OR). Magnetic resonance imaging (MRI) continues to be the most sensitive and preferred diagnostic study for identifying these lesions (6,7). All imaging sequences from preoperative MRIs should be carefully reviewed (Fig. 2). Anatomical location of a tumor, size and distribution of tumor, and edema are often delineated on T1 and T2 sequences; potential cell density 4 O¨cal et al. Figure 2 Magnetic resonance angiogram (A) demonstrates vascular displacement of the left middle cerebral artery from a large malignant glioma.

This chapter will address current surgical strategies and illustrate how these can improve outcome. In addition, the limitations of surgery will be addressed to illustrate where advances are needed. Surgeons can play an 1 2 O¨cal et al. increasingly important role in tumor management as new therapies emerge that include direct application of therapy into the tumor. As these improvements become the new standard of care, neurosurgeons will have important roles in bringing new therapies into use. PRESURGICAL PLANNING Clinical Evaluation Traditionally, brain tumors reach medical attention because they create progressive neurological symptoms that can persist over days to weeks.

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