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Malignant Glioma Surgery: Complication Avoidance

Kole, Max; Rock, Jack


The treatment of patients with high-grade gliomas remains a challenge for modern therapy. Clear treatment guidelines derived from randomized prospective studies in the literature do not exist, and there is some controversy regarding the best treatment for malignant brain tumors. An aggressive surgical philosophy for the treatment of malignant gliomas necessitates a strict avoidance of unanticipated complications. This can be accomplished by careful preoperative planning and patient selection with multidisciplinary input; the application of the latest imaging technology, such as functional MRI (fMRI), magnetoencephalography (MEG), magnetic resonance spectroscopy (MRS), and frameless stereotaxy; meticulous surgical technique; and the use of brain mapping for tumors located in eloquent regions. This article focuses on intraoperative techniques and strategies designed to mitigate potential complications, with special consideration for dominant hemisphere lesions.

Department of Neurological Surgery, Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, Michigan

Address correspondence and reprint requests to Max Kole, MD, Hermelin Brain Tumor Center, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202. E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.