Surgical techniques in the management of intrinsic tumours

Surgical resection plays a central role in the management of intrinsic brain tumours, and there is a growing body of evidence concerning the value of extent of resection to improve patient outcome and quality of life. Maximal resection can be difficult to achieve due to tumour proximity to eloquent structures and uncertainty as to tumour margins. Direct stimulation mapping, functional neuronavigation, intraoperative MRI, and fluorescence-guided surgery are all useful tools to improve the extent of tumour resection while minimizing morbidity. Current evidence suggests that a more extensive surgical resection is associated with longer survival and improved quality of life for patients with either low- or high-grade gliomas. This chapter emphasizes the evidence supporting the role of surgery for intrinsic brain tumours, their surgical neuroanatomy, and techniques to maximize the extent of resection while minimizing morbidity.