The Latest Glioma Surgical Support Devices and Intraoperative Applications of MRI

Abstract

We previously proposed an information-guided surgery based on objective intraoperative information to achieve a high precision and maximum resection of gliomas. In 2000, an "intelligent operating room" was constructed and put into operation as a place to train new "eyes," "hands," and "brains" for surgeons. Based on the positive experience from this room, it was subsequently developed into the Smart Cyber Operating Theater (SCOT), and from October 2019, Hyper SCOT was introduced at Tokyo Women's Medical University Hospital. This report introduces the latest surgical support devices that we have implemented in glioma surgery with Hyper SCOT. As an intraoperative image information support device, intraoperative MRI can correct brain shift, visualize residual tumor, and aid in performing maximal tumor resection, thereby greatly contributing to surgical results. As an intraoperative histological information support device, intraoperative flow cytometry can evaluate the presence of tumor cells and malignancy based on the measurement of the amount of DNA in tumor cells, and also predict the prognosis intraoperatively. Photodynamic therapy has been shown to be effective in clinical trials as an intraoperative treatment support device, and it is covered by insurance. Therefore, it is expected to be established as a standard treatment method for primary glioblastoma patients.