Dual-imaging strategy for the resection of recurrent malignant glioma: Challenges and practical utility

Abstract

Recurrent high-grade gliomas constitute a significant, yet vexing burden of disease in neuro-oncological surgery. Despite evidence supporting the multiple benefits of surgery, radical resection remains difficult in many cases. One of the biggest challenges in its treatment is the difficulty in delineating progressive tumor from the treatment-related changes, namely scarring of prior surgical treatment, pseudoprogression, and radiation-induced gliosis. Neurosurgeons dealing with recurrent gliomas should be familiar with the various adjuncts available. Considering the relative benefits and limitations of each of these techniques, a combined modality approach may be most appropriate in such cases. We describe a case of a recurrent glioma operated using three-dimensional intraoperative ultrasound and 5-Aminolevulinic acid illustrating the role of a dual-imaging approach for malignant gliomas.