Abstract
Background
Maximal safe resection is the principal goal in glioma surgery, requiring refined surgical skills and accurate intraoperative decision-making. In addition to standard tumor resection techniques, we incorporated microsurgical procedures from other domains such as cerebrovascular surgery -including dissection, vessel clipping, and microanastomosis- allowing for more precise and safer operations. Meanwhile, advances in surgical support technologies, including augmented reality (AR), high-resolution exoscopes, and AI-assisted imaging, have greatly improved intraoperative visualization and decision-making. This study presents clinical applications of ‘next-generation glioma surgery’ through the integration of diverse microsurgical techniques and advanced technologies, and discusses future directions and interdisciplinary collaboration.
Methods
A total of 344 glioma resection cases performed since April 2014 at our institution were analyzed. In all cases, vessels and white matter tracts were visualized, and surgical planning was conducted using 3D fusion imaging. In the latter series, high-definition exoscopes, AR, and AI-assisted image analysis were used to visualize perforating arteries and high-resolution tractography. Surgical techniques combined standard tumor resection using suction and CUSA with techniques adapted from other neurosurgical fields. All operative videos were reviewed to evaluate the impact of each technique based on anatomical location and operative scene.
Results
Preoperative simulations enabled accurate feeder control, reducing intraoperative bleeding and improving visualization. High-fidelity imaging and meticulous techniques allowed preservation of passing arteries, perforators, and white matter tracts. In cases of vascular injury, microvascular anastomosis was performed. AR and image enhancement improved the accuracy of 5-ALA-guided resections, contributing to more complete tumor removal. These innovations led to higher resection rates and fewer complications.
Conclusion
The integration of advanced support technologies and refined surgical techniques, including those from other specialties, has driven progress in glioma surgery. Along with continued technological innovation, the transmission and further development of surgical techniques remain important challenges.