The goal of glioma surgery is maximal safe resection in order to provide optimal tumor control and survival benefit to the patient. There are multiple imaging modalities beyond traditional contrast-enhanced magnetic resonance imaging (MRI) that have been incorporated into the preoperative workup of patients presenting with gliomas. The aim of these imaging modalities is to identify cortical and subcortical areas of eloquence, and their relationship to the lesion. In this article, multiple modalities are described with an emphasis on the underlying technology, clinical utilization, advantages, and disadvantages of each. functional MRI and its role in identifying hemispheric dominance and areas of language and motor are discussed. The nuances of magnetoencephalography and transcranial magnetic stimulation in localization of eloquent cortex are examined, as well as the role of diffusion tensor imaging in defining normal white matter tracts in glioma surgery. Lastly, we highlight the role of stimulated Raman spectroscopy in intraoperative histopathological diagnosis of tissue to guide tumor resection. Tumors may shift the normal arrangement of functional anatomy in the brain; thus, utilization of multiple modalities may be helpful in operative planning and patient counseling for successful surgery.

中文翻译：

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胶质瘤管理中的结构和功能成像

胶质瘤手术的目标是最大程度地安全切除，以便为患者提供最佳的肿瘤控制和生存益处。除了传统的对比增强磁共振成像 (MRI) 之外，还有多种成像方式已被纳入神经胶质瘤患者的术前检查中。这些成像方式的目的是识别皮层和皮层下的口才区域，以及它们与病变的关系。在本文中，描述了多种方式，重点介绍了每种方式的基础技术、临床应用、优点和缺点。讨论了功能性 MRI 及其在识别半球优势以及语言和运动领域的作用。检查了脑磁图和经颅磁刺激在雄辩皮层定位中的细微差别，以及扩散张量成像在胶质瘤手术中定义正常白质束中的作用。最后，我们强调了受激拉曼光谱在组织的术中组织病理学诊断中的作用，以指导肿瘤切除。肿瘤可能会改变大脑功能解剖结构的正常排列；因此，多种方式的利用可能有助于手术计划和患者咨询以实现成功手术。肿瘤可能会改变大脑功能解剖结构的正常排列；因此，多种方式的利用可能有助于手术计划和患者咨询以实现成功手术。肿瘤可能会改变大脑功能解剖结构的正常排列；因此，多种方式的利用可能有助于手术计划和患者咨询以实现成功手术。