Cancer Surgery
Open Access

Brain cancer; Neurosurgery; Craniotomy; Minimally invasive surgery; Stereotactic surgery; Intraoperative imaging; MRI; Fluorescence-guided surgery; Intraoperative radiotherapy; Chemotherapy; Neurological function; Multidisciplinary approach; Robotic surgery; Personalized medicine

Introduction

Brain cancer surgery represents one of the most complex and challenging fields in neurosurgery. The primary goal is to remove as much of the tumor as possible while preserving neurological function. Over the past few decades, significant advancements have been made in surgical techniques, imaging technologies, and adjunct therapies, and leading to improved outcomes for patients. This article provides an in-depth review of these advancements, current practices, and future directions in brain cancer surgery. Craniotomy remains the standard procedure for accessing and removing brain tumors [1]. The technique involves removing a portion of the skull to expose the brain and the tumor. Surgeons then use precision tools to excise the tumor. Advances in preoperative planning and intraoperative navigation have significantly enhanced the safety and effectiveness of craniotomies. Minimally invasive approaches, such as endoscopic and keyhole surgeries, have been developed to reduce trauma to surrounding brain tissue [2]. These techniques use smaller incisions and specialized instruments to access and remove tumors, resulting in shorter recovery times and fewer complications. Stereotactic surgery utilizes a three-dimensional coordinate system to locate small targets within the brain. This approach allows for highly precise tumor removal with minimal damage to healthy tissue. Stereotactic techniques are particularly useful for deep-seated or difficult-to-reach tumors. Fluorescence-guided surgery involves the use of fluorescent dyes that selectively accumulate in tumor tissues [3, 4].

Methodology

Special lighting, these dyes make the tumor cells glow, helping surgeons distinguish between healthy and cancerous tissues. This technique has been shown to improve the extent of tumor resection and reduce recurrence rates. Intraoperative radiotherapy (IORT) delivers a concentrated dose of radiation to the tumor bed during surgery. This approach aims to eliminate residual cancer cells and reduce the risk of tumor recurrence. IORT is particularly beneficial for patients with high-grade gliomas and other aggressive brain tumors [5,6]. Chemotherapeutic agents can be administered directly to the tumor site during surgery, enhancing their efficacy and minimizing systemic side effects. Local delivery methods, such as biodegradable wafers impregnated with chemotherapeutic drugs, have been developed to provide sustained release of medication to the tumor bed. Awake craniotomy involves performing brain surgery while the patient is awake and able to respond to stimuli. This technique allows surgeons to monitor and preserve critical neurological functions, such as speech and movement, by mapping the functional areas of the brain in real-time [7]. Functional mapping techniques, such as intraoperative electrical stimulation, help identify and preserve important brain regions during surgery. By precisely locating functional areas, surgeons can avoid damaging essential brain tissues while maximizing tumor resection. The management of brain cancer requires a collaborative approach involving neurosurgeons, neuro-oncologists, radiologists, pathologists, and rehabilitation specialists. This multidisciplinary team works together to develop and implement personalized treatment plans, ensuring comprehensive care for each patient. Regular tumor board meetings and case discussions are essential components of this approach, facilitating the exchange of knowledge and expertise [8]. Robotic systems are being integrated into neurosurgery to enhance precision and control during complex procedures. These systems provide surgeons with greater dexterity and accuracy, allowing for more refined tumor resections. Robotic surgery also holds the potential to reduce surgeon fatigue and improve patient outcomes. Advances in genomic and molecular profiling are paving the way for personalized medicine in brain cancer treatment. By analyzing the genetic makeup of a patient’s tumor, clinicians can identify specific mutations and tailor therapies accordingly. This personalized approach promises to improve treatment efficacy and reduce adverse effects. Artificial intelligence (AI) is being increasingly utilized to assist in the diagnosis, treatment planning, and intraoperative decision-making in brain cancer surgery [9,10]. Machine learning algorithms can analyze vast amounts of data to identify patterns and predict outcomes, aiding surgeons in making more informed decisions.

Results and Discussion

The advancements in brain cancer surgery have led to significant improvements in both short-term and long-term patient outcomes. Key findings from recent studies and clinical trials are summarized .Craniotomy remains the gold standard for brain tumor resection, with enhanced safety and effectiveness due to improved preoperative planning and intraoperative navigation. Minimally invasive techniques, including endoscopic and keyhole surgeries, have shown reduced operative times, lower complication rates, and shorter hospital stays compared to traditional approaches. Stereotactic surgery has provided highly precise tumor removal, especially for deep-seated and difficult-to-reach tumors, with minimal damage to surrounding healthy tissue. The implementation of intraoperative MRI (iMRI) has significantly increased the extent of tumor resection, leading to better overall survival and progression-free survival rates. Studies have demonstrated that iMRI can reduce the incidence of residual tumor tissue and the need for reoperation. Fluorescence-guided surgery using agents like 5-aminolevulinic acid (5-ALA) has improved the visualization of tumor margins, resulting in more complete resections and decreased recurrence rates. Clinical trials have reported higher rates of gross total resection (GTR) in patients undergoing fluorescence-guided surgery. Intraoperative radiotherapy (IORT) has been effective in delivering high doses of radiation directly to the tumor bed, improving local control and reducing recurrence rates in patients with high-grade gliomas. Functional mapping techniques, including intraoperative cortical and subcortical stimulation, have improved the safety of resections near eloquent brain areas, resulting in better functional outcomes and quality of life for patients.

Discussion

The integration of these advanced techniques and technologies into brain cancer surgery has led to substantial improvements in surgical outcomes. However, several challenges and considerations remain; achieving maximal tumor resection while preserving neurological functions is a critical balance. Techniques like awake craniotomy and functional mapping are essential, but they require specialized skills and multidisciplinary collaboration. Advanced technologies such as iMRI and robotic systems are expensive and may not be available in all medical centers, potentially limiting access for some patients. Efforts are needed to make these technologies more widely available and cost-effective. The emergence of personalized medicine based on genomic and molecular profiling is promising but requires further research to identify actionable targets and develop tailored therapies. Integration of personalized approaches into routine clinical practice remains a challenge. The successful implementation of advanced surgical techniques and technologies requires extensive training and experience. Continuing education and specialized training programs are essential to equip neurosurgeons with the necessary skills. While short-term outcomes have improved, long-term survival and quality of life remain critical endpoints. Ongoing research is needed to evaluate the long-term benefits of these advancements and to develop strategies for improving survivorship and reducing late effects of treatment.

Conclusion

Brain cancer surgery has made significant strides, with innovations in surgical techniques, imaging technologies, and adjunct therapies leading to improved patient outcomes. The integration of advanced imaging, minimally invasive methods, and multidisciplinary care has enhanced the precision and safety of brain tumor resections. Looking forward, the adoption of robotic surgery, personalized medicine, and AI holds the promise of further transforming the field, offering new hope for patients battling brain cancer. Continued research and collaboration across specialties will be essential in advancing the science and practice of brain cancer surgery, ultimately improving survival rates and quality of life for patients.

Acknowledgement

None

Conflict of Interest

None

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