{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:30:30Z","timestamp":1789608630234,"version":"build-2803163510"},"reference-count":80,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,1]]},"abstract":"\n OBJECT<\/jats:title>\n Surgery of suspected low-grade gliomas (LGGs) poses a special challenge for neurosurgeons due to their diffusely infiltrative growth and histopathological heterogeneity. Consequently, neuronavigation with multimodality imaging data, such as structural and metabolic data, fiber tracking, and 3D brain visualization, has been proposed to optimize surgery. However, currently no standardized protocol has been established for multimodality imaging data in modern glioma surgery. The aim of this study was therefore to define a specific protocol for multimodality imaging and navigation for suspected LGG.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Fifty-one patients who underwent surgery for a diffusely infiltrating glioma with nonsignificant contrast enhancement on MRI and available multimodality imaging data were included. In the first 40 patients with glioma, the authors retrospectively reviewed the imaging data, including structural MRI (contrast-enhanced T1-weighted, T2-weighted, and FLAIR sequences), metabolic images derived from PET, or MR spectroscopy chemical shift imaging, fiber tracking, and 3D brain surface\/vessel visualization, to define standardized image settings and specific indications for each imaging modality. The feasibility and surgical relevance of this new protocol was subsequently prospectively investigated during surgery with the assistance of an advanced electromagnetic navigation system in the remaining 11 patients. Furthermore, specific surgical outcome parameters, including the extent of resection, histological analysis of the metabolic hotspot, presence of a new postoperative neurological deficit, and intraoperative accuracy of 3D brain visualization models, were assessed in each of these patients.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n After reviewing these first 40 cases of glioma, the authors defined a specific protocol with standardized image settings and specific indications that allows for optimal and simultaneous visualization of structural and metabolic data, fiber tracking, and 3D brain visualization. This new protocol was feasible and was estimated to be surgically relevant during navigation-guided surgery in all 11 patients. According to the authors' predefined surgical outcome parameters, they observed a complete resection in all resectable gliomas (n = 5) by using contour visualization with T2-weighted or FLAIR images. Additionally, tumor tissue derived from the metabolic hotspot showed the presence of malignant tissue in all WHO Grade III or IV gliomas (n = 5). Moreover, no permanent postoperative neurological deficits occurred in any of these patients, and fiber tracking and\/or intraoperative monitoring were applied during surgery in the vast majority of cases (n = 10). Furthermore, the authors found a significant intraoperative topographical correlation of 3D brain surface and vessel models with gyral anatomy and superficial vessels. Finally, real-time navigation with multimodality imaging data using the advanced electromagnetic navigation system was found to be useful for precise guidance to surgical targets, such as the tumor margin or the metabolic hotspot.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In this study, the authors defined a specific protocol for multimodality imaging data in suspected LGGs, and they propose the application of this new protocol for advanced navigation-guided procedures optimally in conjunction with continuous electromagnetic instrument tracking to optimize glioma surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.10.focus14597","type":"journal-article","created":{"date-parts":[[2015,1,1]],"date-time":"2015-01-01T03:36:38Z","timestamp":1420083398000},"page":"E4","source":"Crossref","is-referenced-by-count":41,"title":["Introduction of a standardized multimodality image protocol for navigation-guided surgery of suspected low-grade gliomas"],"prefix":"10.3171","volume":"38","author":[{"given":"Ayg\u00fcl","family":"Mert","sequence":"first","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Kiesel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelheid","family":"W\u00f6hrer","sequence":"additional","affiliation":[{"name":"Institute of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Mart\u00ednez-Moreno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgi","family":"Minchev","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Furtner","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engelbert","family":"Knosp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Wolfsberger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Widhalm","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1-focus14597","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Use of diffusion tensor imaging in glioma resection","volume":"34","author":"Abdullah","year":"2013"},{"key":"b2-focus14597","series-title":"Surgical Pathology of the Nervous System and Its Coverings","author":"Burger","year":"1991"},{"key":"b3-focus14597","series-title":"J Neurosurg","first-page":"1157","article-title":"Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases. Clinical article","volume":"118","author":"Capelle","year":"2013"},{"key":"b4-focus14597","series-title":"Neurotherapeutics","first-page":"465","article-title":"Neuroimaging in neuro-oncology","volume":"6","author":"Cha","year":"2009"},{"key":"b5-focus14597","series-title":"Neurosurgery","first-page":"86","article-title":"Three-dimensional visualization of the pyramidal tract in a neuronavigation system during brain tumor surgery: first experiences and technical note","volume":"49","author":"Coenen","year":"2001"},{"key":"b6-focus14597","series-title":"J Clin Oncol","first-page":"2559","article-title":"Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis","volume":"30","author":"De","year":"2012"},{"key":"b7-focus14597","series-title":"Cancer","first-page":"2622","article-title":"Preferential brain locations of low-grade gliomas","volume":"100","author":"Duffau","year":"2004"},{"key":"b8-focus14597","series-title":"Neurosurgery","first-page":"29","article-title":"A prospective study of the safety and efficacy of frameless, pinless electromagnetic image-guided biopsy of cerebral lesions","volume":"70","author":"Harrisson","year":"2012"},{"key":"b9-focus14597","series-title":"Curr Treat Options Neurol","first-page":"2014","article-title":"Role of surgical resection in low- and high-grade gliomas","volume":"16","author":"Hervey-Jumper"},{"issue":"Suppl 1","key":"b10-focus14597","series-title":"Neurosurgery","first-page":"78","article-title":"Image-guided neurosurgery with 3-dimensional multimodal imaging data on a stereoscopic monitor","volume":"72","author":"Kockro","year":"2013"},{"key":"b11-focus14597","series-title":"Neuro Oncol","first-page":"307","article-title":"Hot spots in dynamic (18)FET-PET delineate malignant tumor parts within suspected WHO grade II gliomas","volume":"13","author":"Kunz","year":"2011"},{"key":"b12-focus14597","series-title":"Minim Invasive Neurosurg","first-page":"278","article-title":"Impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas: a single-institution retrospective study","volume":"47","author":"Kurimoto","year":"2004"},{"key":"b13-focus14597","series-title":"WHO Classification of Tumours of the Central Nervous System","year":"2007"},{"key":"b14-focus14597","series-title":"Neurosurgery","first-page":"ons286","article-title":"Brain tumor surgery with 3-dimensional surface navigation","volume":"71","author":"Mert","year":"2012"},{"issue":"Suppl 1","key":"b15-focus14597","series-title":"Neurosurgery","first-page":"43","article-title":"Advanced cranial navigation","volume":"72","author":"Mert","year":"2013"},{"key":"b16-focus14597","series-title":"Neurosurgery","first-page":"1070","article-title":"Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging","volume":"47","author":"Nimsky","year":"2000"},{"issue":"4 Suppl 2","key":"b17-focus14597","series-title":"Neurosurgery","first-page":"ONS\u2013292","article-title":"Implementation of fiber tract navigation","volume":"58","author":"Nimsky","year":"2006"},{"key":"b18-focus14597","series-title":"Acta Neurochir Suppl","first-page":"207","article-title":"Multimodal navigation integrated with imaging","volume":"109","author":"Nimsky","year":"2011"},{"key":"b19-focus14597","series-title":"Cancer","first-page":"442","article-title":"Intratumoral histologic heterogeneity of gliomas. A quantitative study","volume":"64","author":"Paulus","year":"1989"},{"key":"b20-focus14597","series-title":"J Neurosurg","first-page":"238","article-title":"Integrated positron emission tomography and magnetic resonance imaging-guided resection of brain tumors: a report of 103 consecutive procedures","volume":"104","author":"Pirotte","year":"2006"},{"key":"b21-focus14597","series-title":"Ann Neurol","first-page":"9","article-title":"Current concepts and management of glioblastoma","volume":"70","author":"Preusser","year":"2011"},{"key":"b22-focus14597","series-title":"Neurosurgery","first-page":"749","article-title":"Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases","volume":"43","author":"Roberts","year":"1998"},{"key":"b23-focus14597","series-title":"J Neurosurg","first-page":"545","article-title":"A frameless stereotaxic integration of computerized tomographic imaging and the operating 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Oncol","first-page":"1338","article-title":"Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas","volume":"26","author":"Smith","year":"2008"},{"key":"b29-focus14597","series-title":"Eur J Neurol","first-page":"1124","article-title":"Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force","volume":"17","author":"Soffietti","year":"2010"},{"key":"b30-focus14597","series-title":"J Neurosurg","first-page":"287","article-title":"Integration of biochemical images of a tumor into frameless stereotaxy achieved using a magnetic resonance imaging\/magnetic resonance spectroscopy hybrid data set","volume":"101","author":"Stadlbauer","year":"2004"},{"key":"b31-focus14597","series-title":"Lancet Oncol","first-page":"392","article-title":"Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial","volume":"7","author":"Stummer","year":"2006"},{"key":"b32-focus14597","series-title":"N Engl J Med","first-page":"987","article-title":"Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma","volume":"352","author":"Stupp","year":"2005"},{"key":"b33-focus14597","series-title":"Acta Neurochir (Wien)","first-page":"927","article-title":"Intracranial image-guided neurosurgery: experience with a new electromagnetic navigation system","volume":"143","author":"Suess","year":"2001"},{"key":"b34-focus14597","series-title":"J Neurosurg","first-page":"163","article-title":"Glioma surgery using a multimodal navigation system with integrated metabolic images","volume":"110","author":"Tanaka","year":"2009"},{"key":"b35-focus14597","series-title":"Lancet Oncol","first-page":"583","article-title":"Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas","volume":"12","author":"van den Bent","year":"2011"},{"key":"b36-focus14597","series-title":"Neurosurgery","first-page":"234","article-title":"Application of novel response\/progression measures for surgically delivered therapies for gliomas: Response Assessment in Neuro-Oncology (RANO) Working Group","volume":"70","author":"Vogelbaum","year":"2012"},{"key":"b37-focus14597","series-title":"PLoS ONE","first-page":"e76988","article-title":"5-Aminolevulinic acid induced fluorescence is a powerful intraoperative marker for precise histopathological grading of gliomas with non-significant contrast-enhancement","volume":"8","author":"Widhalm","year":"2013"},{"key":"b38-focus14597","series-title":"J Neurol Neurosurg Psychiatry","first-page":"512","article-title":"Value of 1H-magnetic resonance spectroscopy chemical shift imaging for detection of anaplastic foci in diffusely infiltrating gliomas with non-significant contrast-enhancement","volume":"82","author":"Widhalm","year":"2011"},{"key":"b39-focus14597","series-title":"Cancer","first-page":"1545","article-title":"5-Aminolevulinic acid is a promising marker for detection of anaplastic foci in diffusely infiltrating gliomas with nonsignificant contrast enhancement","volume":"116","author":"Widhalm","year":"2010"},{"key":"b40-focus14597","series-title":"Neurol Res","first-page":"354","article-title":"The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery","volume":"22","author":"Wirtz","year":"2000"},{"issue":"4","key":"b1-focus14597","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Use of diffusion tensor imaging in glioma resection","volume":"34","author":"Abdullah","year":"2013"},{"key":"b2-focus14597","series-title":"Surgical Pathology of the Nervous System and Its Coverings","author":"Burger","year":"1991"},{"key":"b3-focus14597","series-title":"J Neurosurg","first-page":"1157","article-title":"Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases. 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A quantitative study","volume":"64","author":"Paulus","year":"1989"},{"key":"b20-focus14597","series-title":"J Neurosurg","first-page":"238","article-title":"Integrated positron emission tomography and magnetic resonance imaging-guided resection of brain tumors: a report of 103 consecutive procedures","volume":"104","author":"Pirotte","year":"2006"},{"key":"b21-focus14597","series-title":"Ann Neurol","first-page":"9","article-title":"Current concepts and management of glioblastoma","volume":"70","author":"Preusser","year":"2011"},{"key":"b22-focus14597","series-title":"Neurosurgery","first-page":"749","article-title":"Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases","volume":"43","author":"Roberts","year":"1998"},{"key":"b23-focus14597","series-title":"J Neurosurg","first-page":"545","article-title":"A frameless stereotaxic integration of computerized tomographic imaging and the operating 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Oncol","first-page":"1338","article-title":"Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas","volume":"26","author":"Smith","year":"2008"},{"key":"b29-focus14597","series-title":"Eur J Neurol","first-page":"1124","article-title":"Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force","volume":"17","author":"Soffietti","year":"2010"},{"key":"b30-focus14597","series-title":"J Neurosurg","first-page":"287","article-title":"Integration of biochemical images of a tumor into frameless stereotaxy achieved using a magnetic resonance imaging\/magnetic resonance spectroscopy hybrid data set","volume":"101","author":"Stadlbauer","year":"2004"},{"key":"b31-focus14597","series-title":"Lancet Oncol","first-page":"392","article-title":"Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial","volume":"7","author":"Stummer","year":"2006"},{"key":"b32-focus14597","series-title":"N Engl J Med","first-page":"987","article-title":"Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma","volume":"352","author":"Stupp","year":"2005"},{"key":"b33-focus14597","series-title":"Acta Neurochir (Wien)","first-page":"927","article-title":"Intracranial image-guided neurosurgery: experience with a new electromagnetic navigation system","volume":"143","author":"Suess","year":"2001"},{"key":"b34-focus14597","series-title":"J Neurosurg","first-page":"163","article-title":"Glioma surgery using a multimodal navigation system with integrated metabolic images","volume":"110","author":"Tanaka","year":"2009"},{"key":"b35-focus14597","series-title":"Lancet Oncol","first-page":"583","article-title":"Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas","volume":"12","author":"van den Bent","year":"2011"},{"key":"b36-focus14597","series-title":"Neurosurgery","first-page":"234","article-title":"Application of novel response\/progression measures for surgically delivered therapies for gliomas: Response Assessment in Neuro-Oncology (RANO) Working Group","volume":"70","author":"Vogelbaum","year":"2012"},{"key":"b37-focus14597","series-title":"PLoS ONE","first-page":"e76988","article-title":"5-Aminolevulinic acid induced fluorescence is a powerful intraoperative marker for precise histopathological grading of gliomas with non-significant contrast-enhancement","volume":"8","author":"Widhalm","year":"2013"},{"key":"b38-focus14597","series-title":"J Neurol Neurosurg Psychiatry","first-page":"512","article-title":"Value of 1H-magnetic resonance spectroscopy chemical shift imaging for detection of anaplastic foci in diffusely infiltrating gliomas with non-significant 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