Choline PET/CT and intraoperative management of primary brain tumors. New insights for contemporary neurosurgery
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Choline PET/CT and intraoperative management of primary brain tumors. New insights for contemporary neurosurgery Ignazio G. Vetrano1 · Riccardo Laudicella2 · Pierpaolo Alongi3 Received: 1 September 2020 / Accepted: 21 October 2020 © Italian Association of Nuclear Medicine and Molecular Imaging 2020
Maximal safe resection represents the main aim of brain tumor surgery. Increasing the extent of tumor removal but preserving neurologic functions is the basilar concept of contemporary neurosurgery. This concept is particularly true for primary brain tumors, mainly gliomas. The differences in the clinical presentation, tumor location, biological behavior, and bio-molecular characteristics determine the need for a strictly individualized approach to a patient harboring a glioma. This necessity demanded, during the last years, continuous improvement of pre- and intra-operative imaging techniques, to optimize the surgical goals. Since its introduction, magnetic resonance imaging (MRI) has acquired the main diagnostic role in preoperative diagnosis, and also as intra-operative surgical guidance. MRI is, therefore, the modality of choice for the diagnosis and follow-up of glioma patients. Whereas this technique provides excellent anatomic details, MRI is not always able to supply exact functional information about tumor’s grading and proliferative activity, despite advanced MRI sequences are becoming widely used to characterize altered metabolism. Namely, in some conditions as intra-tumoral bleeding, the pivotal role of MRI could be limited: although rarely, the primary diagnosis based on MRI-only, could be difficult to achieve. This aspect acquires particular relevance in the intra-operative setting: thanks to continuous technological advancements, neurosurgery has greatly benefited from a strict interaction with imaging modalities. The availability of intra-operative tools for imaging-guided surgery, determining a more robust * Pierpaolo Alongi [email protected] 1
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
2
Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho‑Functional Imaging, University of Messina, 98125 Messina, Italy
3
Unit of Nuclear Medicine, Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, 90015 Cefalu, Italy
accuracy in spatial orientation, has contributed to improving the neurosurgeon’s ability to perform surgical procedures that minimize the risks for the patients. Neuronavigation, based on pre-operative imaging (mainly MRI), allow realtime visualization of tridimensional reconstructions from intracranial structures, guiding, therefore, craniotomy marking and planning the route of surgical procedure or biopsy. However, the tumor tissues delineated by MRI may not always correlate with the neoplasm portion having the highest grade potential. This could affect the identification of the optimal biopsy target, or impair the extent of resection. In neuro-oncology, positron emission tomograp
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