{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:01:01Z","timestamp":1792789261726,"version":"4.5.0"},"reference-count":112,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad de las Am\u00e9ricas","award":["592.A.XVII.25"],"award-info":[{"award-number":["592.A.XVII.25"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Advances in neuroimaging and intraoperative mapping have transformed brain tumour surgery from anatomy-based resection to function-guided intervention. This review synthesises current evidence on multimodal strategies for maximising tumour removal while preserving cognitive and neurological function. Integrating task-based and resting-state functional MRI (fMRI), diffusion tensor imaging (DTI), tractography, and connectomic analysis enables personalised mapping of eloquent and cognitive networks. Intraoperatively, awake craniotomy with direct electrical stimulation (DES) remains the gold standard for real-time functional validation, while adjuncts such as intraoperative MRI (iMRI), 5-aminolevulinic acid (5-ALA) fluorescence, and ultrasound-based extended resection accuracy. However, these technologies present unique limitations, including neurovascular uncoupling in fMRI, tract distortion in DTI, and resource constraints in low-income settings. Our review differentiates their application across low-grade and high-grade gliomas, emphasising that tumour biology determines the balance between neuroplasticity-driven mapping and imaging-guided radicality. Key future priorities include validation of multimodal imaging protocols, integration of longitudinal neuropsychological outcomes, and development of interpretable connectomic models. Addressing the technological and ethical challenges of high-field MRI, data standardisation, and cost-effective implementation will be essential for equitable global adoption. Ultimately, the evolution of functional neurosurgery depends not only on new technologies but on integrating multimodal evidence and patient-centred outcome measures to achieve reproducible, safe, and personalised brain tumour surgery.<\/jats:p>","DOI":"10.3390\/cancers17243890","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T13:17:07Z","timestamp":1764940627000},"page":"3890","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Advances in Preoperative and Intraoperative Technologies for Safe Resection of Gliomas in Cognitive Regions"],"prefix":"10.3390","volume":"17","author":[{"given":"Valentina","family":"Vintimilla Rivadeneira","sequence":"first","affiliation":[{"name":"NeurALL Research Group, Quito 170157, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8130-6460","authenticated-orcid":false,"given":"Jose E.","family":"Leon-Rojas","sequence":"additional","affiliation":[{"name":"Cerebro, Emoci\u00f3n y Conducta (CEC) Research Group, Escuela de Medicina, Universidad de las Am\u00e9ricas (UDLA), Quito 170124, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"vi1","DOI":"10.1093\/neuonc\/noae145","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2017\u20132021","volume":"26","author":"Price","year":"2024","journal-title":"Neuro-Oncology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1093\/neuonc\/noab106","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: A Summary","volume":"23","author":"Louis","year":"2021","journal-title":"Neuro-Oncology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1056\/NEJMoa043330","article-title":"Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma","volume":"352","author":"Stupp","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Polonara, G., Aiudi, D., Iacoangeli, A., Raggi, A., Ottaviani, M.M., Antonini, R., Iacoangeli, M., and Dobran, M. (2023). Glioblastoma: A Retrospective Analysis of the Role of the Maximal Surgical Resection on Overall Survival and Progression Free Survival. Biomedicines, 11.","DOI":"10.3390\/biomedicines11030739"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3171\/2008.4.17536","article-title":"Independent Association of Extent of Resection with Survival in Patients with Malignant Brain Astrocytoma","volume":"110","author":"McGirt","year":"2009","journal-title":"J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.3171\/2017.3.JNS17659","article-title":"Eloquent: History of a Word\u2019s Adoption into the Neurosurgical Lexicon","volume":"127","author":"Kahn","year":"2017","journal-title":"J. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chohan, M.O., Flores, R.A., Wertz, C., and Jung, R.E. (2024). \u201cNon-Eloquent\u201d Brain Regions Predict Neuropsychological Outcome in Tumor Patients Undergoing Awake Craniotomy. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0284261"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Xiao, Y., Tan, J., Cheng, G., and Deng, Y. (2025). The Relationship between Social Participation and Cognitive Function Early after Surgery of Glioma Patients. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0319220"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s00701-013-1653-9","article-title":"The \u201cOnco-Functional Balance\u201d in Surgery for Diffuse Low-Grade Glioma: Integrating the Extent of Resection with Quality of Life","volume":"155","author":"Duffau","year":"2013","journal-title":"Acta Neurochir."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1007\/s00701-022-05261-3","article-title":"Patient-Reported Cognitive Function before and after Glioma Surgery","volume":"164","author":"Schei","year":"2022","journal-title":"Acta Neurochir."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1148\/radiol.2482071214","article-title":"Presurgical Functional MR Imaging of Language and Motor Functions: Validation with Intraoperative Electrocortical Mapping","volume":"248","author":"Bizzi","year":"2008","journal-title":"Radiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"103219","DOI":"10.1016\/j.nicl.2022.103219","article-title":"Presurgical Predictors of Early Cognitive Outcome after Brain Tumor Resection in Glioma Patients","volume":"36","author":"Zangrossi","year":"2022","journal-title":"NeuroImage Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s00701-012-1275-7","article-title":"The Challenge to Remove Diffuse Low-Grade Gliomas While Preserving Brain Functions","volume":"154","author":"Duffau","year":"2012","journal-title":"Acta Neurochir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S1470-2045(06)70665-9","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","journal-title":"Lancet Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2019.11.FOCUS19785","article-title":"Tractography and the Connectome in Neurosurgical Treatment of Gliomas: The Premise, the Progress, and the Potential","volume":"48","author":"Henderson","year":"2020","journal-title":"Neurosurg. Focus"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Falc\u00f3-Roget, J., Cacciola, A., Sambataro, F., and Crimi, A. (2024). Functional and Structural Reorganization in Brain Tumors: A Machine Learning Approach Using Desynchronized Functional Oscillations. Commun. Biol., 7.","DOI":"10.1038\/s42003-024-06119-3"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"vdad151","DOI":"10.1093\/noajnl\/vdad151","article-title":"Structural Connectome-Based Predictive Modeling of Cognitive Deficits in Treated Glioma Patients","volume":"6","author":"Friedrich","year":"2024","journal-title":"Neuro-Oncology Adv."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1148\/radiol.2021204723","article-title":"Can Preoperative Mapping with Functional MRI Reduce Morbidity in Brain Tumor Resection? A Systematic Review and Meta-Analysis of 68 Observational Studies","volume":"300","author":"Luna","year":"2021","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Park, K.Y., Lee, J.J., Dierker, D., Marple, L.M., Hacker, C.D., Roland, J.L., Marcus, D.S., Milchenko, M., Miller-Thomas, M.M., and Benzinger, T.L. (2020). Mapping Language Function with Task-Based vs. Resting-State Functional MRI. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0236423"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.nicl.2017.12.008","article-title":"Challenges and Techniques for Presurgical Brain Mapping with Functional MRI","volume":"17","author":"Silva","year":"2018","journal-title":"NeuroImage Clin."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/jon.12597","article-title":"Functional MRI Task Comparison for Language Mapping in Neurosurgical Patients","volume":"29","author":"Unadkat","year":"2019","journal-title":"J. Neuroimaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s40644-020-00327-w","article-title":"The Role of Resting-State Functional MRI for Clinical Preoperative Language Mapping","volume":"20","author":"Kumar","year":"2020","journal-title":"Cancer Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"274","DOI":"10.3174\/ajnr.A7806","article-title":"Identification of the Language Network from Resting-State fMRI in Patients with Brain Tumors: How Accurate Are Experts?","volume":"44","author":"Gujar","year":"2023","journal-title":"Am. J. Neuroradiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70027","DOI":"10.1111\/jon.70027","article-title":"Resting-State fMRI to Map Language Function for Surgical Planning in Patients with Brain Tumors: A Feasibility Study","volume":"35","author":"Bozzano","year":"2025","journal-title":"J. Neuroimaging"},{"key":"ref_25","first-page":"20200002","article-title":"The Role of Preoperative Diffusion Tensor Imaging in Predicting and Improving Functional Outcome in Pediatric Patients Undergoing Epilepsy Surgery: A Systematic Review","volume":"3","author":"Cornell","year":"2021","journal-title":"BJR Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"839","DOI":"10.3171\/2012.8.JNS12348","article-title":"Correlation between Language Function and the Left Arcuate Fasciculus Detected by Diffusion Tensor Imaging Tractography after Brain Tumor Surgery","volume":"117","author":"Hayashi","year":"2012","journal-title":"J. Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"51","DOI":"10.25259\/SNI_862_2020","article-title":"Acute Changes in Diffusion Tensor-Derived Metrics and Its Correlation with the Motor Outcome in Gliomas Adjacent to the Corticospinal Tract","volume":"12","author":"Cepeda","year":"2021","journal-title":"Surg. Neurol. Int."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Salvati, L.F., De Marco, R., Palmieri, G., Minardi, M., Massara, A., Pesaresi, A., Cagetti, B., Melcarne, A., and Garbossa, D. (2021). The Relevant Role of Navigated Tractography in Speech Eloquent Area Glioma Surgery: Single Center Experience. Brain Sci., 11.","DOI":"10.3390\/brainsci11111436"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"118651","DOI":"10.1016\/j.neuroimage.2021.118651","article-title":"Tractography Methods and Findings in Brain Tumors and Traumatic Brain Injury","volume":"245","author":"Yeh","year":"2021","journal-title":"NeuroImage"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.inat.2016.11.003","article-title":"The Usefulness of Arcuate Fasciculus Tractography Integrated Navigation for Glioma Surgery near the Language Area; Clinical Investigation","volume":"7","author":"Mukae","year":"2017","journal-title":"Interdiscip. Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Shi, J., Lu, D., Pan, R., Chen, H., Teng, H., Xu, Y., Bo, F., Zhou, Q., and Zhang, Y. (2022). Applications of Diffusion Tensor Imaging Integrated with Neuronavigation to Prevent Visual Damage during Tumor Resection in the Optic Radiation Area. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.955418"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ille, S., Engel, L., Kelm, A., Meyer, B., and Krieg, S.M. (2018). Language-Eloquent White Matter Pathway Tractography and the Course of Language Function in Glioma Patients. Front. Oncol., 8.","DOI":"10.3389\/fonc.2018.00572"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s00701-018-3732-4","article-title":"Impact of Intraoperative Stimulation Mapping on High-Grade Glioma Surgery Outcome: A Meta-Analysis","volume":"161","author":"Gerritsen","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.neuroimage.2012.03.072","article-title":"NODDI: Practical In Vivo Neurite Orientation Dispersion and Density Imaging of the Human Brain","volume":"61","author":"Zhang","year":"2012","journal-title":"NeuroImage"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.3174\/ajnr.A3471","article-title":"High Angular Resolution Diffusion Imaging Probabilistic Tractography of the Auditory Radiation","volume":"34","author":"Berman","year":"2013","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/j.neuroimage.2007.02.016","article-title":"Robust Determination of the Fibre Orientation Distribution in Diffusion MRI: Non-Negativity Constrained Super-Resolved Spherical Deconvolution","volume":"35","author":"Tournier","year":"2007","journal-title":"NeuroImage"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/nn.4502","article-title":"Network Neuroscience","volume":"20","author":"Bassett","year":"2017","journal-title":"Nat. Neurosci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"612","DOI":"10.23736\/S0390-5616.17.04017-6","article-title":"Mapping the Connectome in Awake Surgery for Gliomas: An Update","volume":"61","author":"Duffau","year":"2017","journal-title":"J. Neurosurg. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Samuel, N., Vetkas, A., Pancholi, A., Sarica, C., Loh, A., Germann, J., Harmsen, I.E., Tasserie, J., Milano, V., and Yamamoto, K. (2021). A Network-Based Approach to Glioma Surgery: Insights from Functional Neurosurgery. Cancers, 13.","DOI":"10.3390\/cancers13236127"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"102541","DOI":"10.1016\/j.nicl.2020.102541","article-title":"Towards a Tractography-Based Risk Stratification Model for Language Area Associated Gliomas","volume":"29","author":"Tuncer","year":"2020","journal-title":"NeuroImage Clin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1227\/neu.0000000000003012","article-title":"Resting State Functional Networks in Gliomas: Validation with Direct Electric Stimulation Using a New Tool for Planning Brain Resections","volume":"95","author":"Moretto","year":"2024","journal-title":"Neurosurgery"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1200\/JCO.2011.38.4818","article-title":"Impact of Intraoperative Stimulation Brain Mapping on Glioma Surgery Outcome: A Meta-Analysis","volume":"30","author":"Robles","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3055","DOI":"10.1007\/s00701-020-04561-w","article-title":"Experience with Awake throughout Craniotomy in Tumour Surgery: Technique and Outcomes of a Prospective, Consecutive Case Series with Patient Perception Data","volume":"162","author":"Ekert","year":"2020","journal-title":"Acta Neurochir."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s00701-014-2249-8","article-title":"The Evolution of Brain Surgery on Awake Patients","volume":"157","author":"Surbeck","year":"2015","journal-title":"Acta Neurochir."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bu, L., Lu, J., Zhang, J., and Wu, J. (2021). Intraoperative Cognitive Mapping Tasks for Direct Electrical Stimulation in Clinical and Neuroscientific Contexts. Front. Hum. Neurosci., 15.","DOI":"10.3389\/fnhum.2021.612891"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s11060-019-03341-6","article-title":"Neurocognitive Changes after Awake Surgery in Glioma Patients: A Retrospective Cohort Study","volume":"146","author":"Snijders","year":"2020","journal-title":"J. Neurooncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1007\/s00701-024-06062-6","article-title":"An Update on Tests Used for Intraoperative Monitoring of Cognition during Awake Craniotomy","volume":"166","author":"Ruis","year":"2024","journal-title":"Acta Neurochir."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.3171\/2013.6.JNS122470","article-title":"Selection of Intraoperative Tasks for Awake Mapping Based on Relationships between Tumor Location and Functional Networks","volume":"119","author":"Coello","year":"2013","journal-title":"J. Neurosurg."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Mandonnet, E., and Herbet, G. (2021). Beyond Task: When Experience Shapes Intuition. Intraoperative Mapping of Cognitive Networks: Which Tasks for Which Locations, Springer International Publishing.","DOI":"10.1007\/978-3-030-75071-8"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Duffau, H., Ng, S., Lemaitre, A.-L., Moritz-Gasser, S., and Herbet, G. (2022). Constant Multi-Tasking with Time Constraint to Preserve Across-Network Dynamics Throughout Awake Surgery for Low-Grade Glioma: A Necessary Step to Enable Patients Resuming an Active Life. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.924762"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.nec.2020.09.001","article-title":"Functional Mapping for Glioma Surgery, Part 2: Intraoperative Mapping Tools","volume":"32","author":"Morshed","year":"2021","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"148","DOI":"10.2463\/mrms.rev.2021-0116","article-title":"Intraoperative MR Imaging during Glioma Resection","volume":"21","author":"Matsumae","year":"2022","journal-title":"Magn. Reson. Med. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1055\/s-0042-1751008","article-title":"Impact of Intraoperative Magnetic Resonance Imaging (i-MRI) on Surgeon Decision Making and Clinical Outcomes in Cranial Tumor Surgery","volume":"17","author":"Bunyaratavej","year":"2022","journal-title":"Asian J. Neurosurg."},{"key":"ref_54","first-page":"e64697","article-title":"Optimizing Glioma Resection Outcomes: A Systematic Review of Intraoperative Magnetic Resonance Imaging Guidance in Neurosurgery","volume":"16","author":"Ali","year":"2024","journal-title":"Cureus"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1007\/s10143-025-03631-w","article-title":"Efficacy and Safety of Intraoperative Magnetic Resonance Imaging for Low-Grade and High-Grade Gliomas: An Updated Systematic Review and Meta-Analysis","volume":"48","author":"Baptista","year":"2025","journal-title":"Neurosurg. Rev."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.wneu.2021.01.089","article-title":"Intraoperative Magnetic Resonance Imaging for Low-Grade and High-Grade Gliomas: What Is the Evidence? A Meta-Analysis","volume":"149","author":"Lo","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.3171\/2024.7.JNS241102","article-title":"Efficacy and Safety of Intraoperative MRI in Glioma Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized Controlled Trials","volume":"142","author":"Wach","year":"2025","journal-title":"J. Neurosurg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1227\/01.neu.0000430321.39870.be","article-title":"The Impact of High-Field-Strength Intraoperative Magnetic Resonance Imaging on Brain Tumor Management","volume":"60","author":"Haydon","year":"2013","journal-title":"Neurosurgery"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"113528","DOI":"10.1016\/j.ejca.2024.113528","article-title":"Effect of High-Field iMRI Guided Resection in Cerebral Glioma Surgery: A Randomized Clinical Trial","volume":"199","author":"Li","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1227\/01.NEU.0000345647.58219.07","article-title":"Impact of Intraoperative High-Field Magnetic Resonance Imaging Guidance on Glioma Surgery: A Prospective Volumetric Analysis","volume":"64","author":"Hatiboglu","year":"2009","journal-title":"Neurosurgery"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Chanbour, H., and Chotai, S. (2022). Review of Intraoperative Adjuncts for Maximal Safe Resection of Gliomas and Its Impact on Outcomes. Cancers, 14.","DOI":"10.3390\/cancers14225705"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s10143-017-0907-z","article-title":"Maximizing Safe Resections: The Roles of 5-Aminolevulinic Acid and Intraoperative MR Imaging in Glioma Surgery\u2014Review of the Literature","volume":"42","author":"Schipmann","year":"2019","journal-title":"Neurosurg. Rev."},{"key":"ref_63","first-page":"e62278","article-title":"Intraoperative Ultrasound: An Old but Ever New Technology for a More Personalized Approach to Brain Tumor Surgery","volume":"16","author":"Nurmukhametov","year":"2024","journal-title":"Cureus"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.1007\/s10143-022-01778-4","article-title":"Intraoperative Ultrasound in Brain Tumor Surgery: A Review and Implementation Guide","volume":"45","author":"Dixon","year":"2022","journal-title":"Neurosurg. Rev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2015.11.FOCUS15573","article-title":"Identification of Residual Tumor with Intraoperative Contrast-Enhanced Ultrasound during Glioblastoma Resection","volume":"40","author":"Prada","year":"2016","journal-title":"Neurosurg. Focus"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Wu, H., Cheng, Y., Gao, W., Chen, P., Wei, Y., Zhao, H., and Wang, F. (2024). Progress in the Application of Ultrasound in Glioma Surgery. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1388728"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Prada, F., Mattei, L., Del Bene, M., Aiani, L., Saini, M., Casali, C., Filippini, A., Legnani, F.G., Perin, A., and Saladino, A. (2014). Intraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound. BioMed Res. Int., 2014.","DOI":"10.1155\/2014\/484261"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1055\/s-2006-947997","article-title":"Application of Intraoperative 3D Ultrasound During Navigated Tumor Resection","volume":"49","author":"Lindner","year":"2006","journal-title":"Minim. Invasive Neurosurg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1109\/TMI.2019.2935060","article-title":"Evaluation of MRI to Ultrasound Registration Methods for Brain Shift Correction: The CuRIOUS2018 Challenge","volume":"39","author":"Xiao","year":"2020","journal-title":"IEEE Trans. Med. Imaging"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s10143-015-0698-z","article-title":"The Influence of Intraoperative Resection Control Modalities on Survival Following Gross Total Resection of Glioblastoma","volume":"39","author":"Neidert","year":"2016","journal-title":"Neurosurg. Rev."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1227\/NEU.0000000000001112","article-title":"Portable Intraoperative Computed Tomography Scan in Image-Guided Surgery for Brain High-Grade Gliomas: Analysis of Technical Feasibility and Impact on Extent of Tumor Resection","volume":"12","author":"Barbagallo","year":"2016","journal-title":"Oper. Neurosurg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/2019.8.FOCUS19621","article-title":"Reliable Navigation Registration in Cranial and Spine Surgery Based on Intraoperative Computed Tomography","volume":"47","author":"Carl","year":"2019","journal-title":"Neurosurg. Focus"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1177\/21925682221078239","article-title":"The Use of Intraoperative CT Hounsfield Unit Values for the Assessment of Bone Quality in Patients Undergoing Lumbar Interbody Fusion","volume":"13","author":"Mertens","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/0090-3019(82)90319-6","article-title":"Experience with Intraoperative CT Scanning in Brain Tumors","volume":"17","author":"Shalit","year":"1982","journal-title":"Surg. Neurol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"247","DOI":"10.25259\/SNI_303_2020","article-title":"Role of Intraoperative Computed Tomography Scanner in Modern Neurosurgery\u2014An Early Experience","volume":"11","author":"Ashraf","year":"2020","journal-title":"Surg. Neurol. Int."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1002\/mds.26056","article-title":"Validation of CT-MRI Fusion for Intraoperative Assessment of Stereotactic Accuracy in DBS Surgery","volume":"29","author":"Mirzadeh","year":"2014","journal-title":"Mov. Disord."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.nec.2020.09.003","article-title":"Intraoperative Imaging for High-Grade Glioma Surgery","volume":"32","author":"Noh","year":"2021","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s11060-019-03098-y","article-title":"5-ALA and FDA Approval for Glioma Surgery","volume":"141","author":"Hadjipanayis","year":"2019","journal-title":"J. Neurooncol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00701-016-3028-5","article-title":"Agents for Fluorescence-Guided Glioma Surgery: A Systematic Review of Preclinical and Clinical Results","volume":"159","author":"Senders","year":"2017","journal-title":"Acta Neurochir."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Pacioni, S., D\u2019Alessandris, Q.G., Giannetti, S., Della Pepa, G.M., Offi, M., Giordano, M., Caccavella, V.M., Falchetti, M.L., Lauretti, L., and Pallini, R. (2022). 5-Aminolevulinic Acid (5-ALA)-Induced Protoporphyrin IX Fluorescence by Glioma Cells\u2014A Fluorescence Microscopy Clinical Study. Cancers, 14.","DOI":"10.3390\/cancers14122844"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Romeo, E., Tzakos, A.G., Crook, T., Syed, N., Voulgaris, S., and Alexiou, G.A. (2025). Agents for Fluorescence-Guided Glioblastoma Surgery. Pharmaceutics, 17.","DOI":"10.3390\/pharmaceutics17050637"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1227\/NEU.0000000000001035","article-title":"Combining 5-Aminolevulinic Acid Fluorescence and Intraoperative Magnetic Resonance Imaging in Glioblastoma Surgery: A Histology-Based Evaluation","volume":"78","author":"Hauser","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s11060-024-04875-0","article-title":"Predicting Intraoperative 5-ALA-Induced Tumor Fluorescence via MRI and Deep Learning in Gliomas with Radiographic Lower-Grade Characteristics","volume":"171","author":"Azemi","year":"2025","journal-title":"J. Neurooncol."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Shimizu, K., Tamura, K., Hara, S., Inaji, M., Tanaka, Y., Kobayashi, D., Sugawara, T., Wakimoto, H., Nariai, T., and Ishii, K. (2022). Correlation of Intraoperative 5-ALA-Induced Fluorescence Intensity and Preoperative 11C-Methionine PET Uptake in Glioma Surgery. Cancers, 14.","DOI":"10.3390\/cancers14061449"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Della Pepa, G.M., Menna, G., and Olivi, A. (2023). Technical Pearls to Effectively Use 5-ALA in Fluorescence-Guided Tumor Resection\u20145 Lessons from the Operating Room. Brain Sci., 13.","DOI":"10.3390\/brainsci13030411"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1093\/neuonc\/noac191","article-title":"Turning on the Light for Brain Tumor Surgery: A 5-Aminolevulinic Acid Story","volume":"24","author":"McCracken","year":"2022","journal-title":"Neuro-Oncology"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.wneu.2011.02.005","article-title":"Impact of the Combination of 5-Aminolevulinic Acid\u2013Induced Fluorescence with Intraoperative Magnetic Resonance Imaging\u2013Guided Surgery for Glioma","volume":"76","author":"Tsugu","year":"2011","journal-title":"World Neurosurg."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1158\/1078-0432.CCR-17-1184","article-title":"Fluorescein-Guided Surgery for Resection of High-Grade Gliomas: A Multicentric Prospective Phase II Study (FLUOGLIO)","volume":"24","author":"Acerbi","year":"2018","journal-title":"Clin. Cancer Res."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s10143-014-0546-6","article-title":"Fluorescein-Guided Surgery for Malignant Gliomas: A Review","volume":"37","author":"Acerbi","year":"2014","journal-title":"Neurosurg. Rev."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"H\u00f6hne, J., Acerbi, F., Falco, J., Ak\u00e7akaya, M.O., Schmidt, N.O., Kiris, T., De Laurentis, C., Ferroli, P., Broggi, M., and Schebesch, K.-M. (2020). Lighting Up the Tumor\u2014Fluorescein-Guided Resection of Gangliogliomas. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082405"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Ahrens, L.C., Krabbenh\u00f8ft, M.G., Hansen, R.W., Mikic, N., Pedersen, C.B., Poulsen, F.R., and Korshoej, A.R. (2022). Effect of 5-Aminolevulinic Acid and Sodium Fluorescein on the Extent of Resection in High-Grade Gliomas and Brain Metastasis. Cancers, 14.","DOI":"10.3390\/cancers14030617"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"101690","DOI":"10.1016\/j.bas.2022.101690","article-title":"Fluorescein-Guided Resection of Newly Diagnosed High-Grade Glioma: Impact on Extent of Resection and Outcome","volume":"2","author":"Schebesch","year":"2022","journal-title":"Brain Spine"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s00432-024-05796-1","article-title":"Fluorescein-Guided Surgery in High-Grade Gliomas: Focusing on the Eloquent and Deep-Seated Areas","volume":"150","author":"Xiao","year":"2024","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Pesaresi, A., La Cava, P., Bonada, M., Zeppa, P., Melcarne, A., Cofano, F., Fiaschi, P., Garbossa, D., and Bianconi, A. (2024). Combined Fluorescence-Guided Surgery with 5-Aminolevulinic Acid and Fluorescein in Glioblastoma: Technical Description and Report of 100 Cases. Cancers, 16.","DOI":"10.3390\/cancers16162771"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Bianconi, A., Bonada, M., Zeppa, P., Colonna, S., Tartara, F., Melcarne, A., Garbossa, D., and Cofano, F. (2023). How Reliable Is Fluorescence-Guided Surgery in Low-Grade Gliomas? A Systematic Review Concerning Different Fluorophores. Cancers, 15.","DOI":"10.3390\/cancers15164130"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"E641","DOI":"10.1093\/neuros\/nyz125","article-title":"Phase 1 Safety, Pharmacokinetics, and Fluorescence Imaging Study of Tozuleristide (BLZ-100) in Adults with Newly Diagnosed or Recurrent Gliomas","volume":"85","author":"Patil","year":"2019","journal-title":"Neurosurgery"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s10555-018-9770-9","article-title":"Applications of Raman Spectroscopy in Cancer Diagnosis","volume":"37","author":"Auner","year":"2018","journal-title":"Cancer Metastasis Rev."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Ius, T., Mazzucchi, E., Tomasino, B., Pauletto, G., Sabatino, G., Della Pepa, G.M., La Rocca, G., Battistella, C., Olivi, A., and Skrap, M. (2021). Multimodal Integrated Approaches in Low Grade Glioma Surgery. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-87924-2"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"E20","DOI":"10.3171\/2020.10.FOCUS20744","article-title":"Recurrent High-Grade Glioma Surgery: A Multimodal Intraoperative Protocol to Safely Increase Extent of Tumor Resection and Analysis of Its Impact on Patient Outcome","volume":"50","author":"Certo","year":"2021","journal-title":"Neurosurg. Focus"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s11065-021-09512-5","article-title":"Graph Theoretical Analysis of Brain Network Characteristics in Brain Tumor Patients: A Systematic Review","volume":"32","author":"Semmel","year":"2022","journal-title":"Neuropsychol. Rev."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"102435","DOI":"10.1016\/j.nicl.2020.102435","article-title":"What Do We Know about Pre- and Postoperative Plasticity in Patients with Glioma? A Review of Neuroimaging and Intraoperative Mapping Studies","volume":"28","author":"Cargnelutti","year":"2020","journal-title":"NeuroImage Clin."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Hey, G., Guyot, M., Carter, A., and Lucke-Wold, B. (2023). Augmented Reality in Neurosurgery: A New Paradigm for Training. Medicina, 59.","DOI":"10.3390\/medicina59101721"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.4103\/2152-7806.151321","article-title":"Robotics in the Neurosurgical Treatment of Glioma","volume":"6","author":"Sutherland","year":"2015","journal-title":"Surg. Neurol. Int."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Shaffer, A., Kwok, S.S., Naik, A., Anderson, A.T., Lam, F., Wszalek, T., Arnold, P.M., and Hassaneen, W. (2022). Ultra-High-Field MRI in the Diagnosis and Management of Gliomas: A Systematic Review. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.857825"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"111073","DOI":"10.1016\/j.jocn.2025.111073","article-title":"Artificial Intelligence for Brain Neuroanatomical Segmentation in Magnetic Resonance Imaging: A Literature Review","volume":"134","author":"Andrews","year":"2025","journal-title":"J. Clin. Neurosci."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1186\/s13244-021-01102-6","article-title":"Clinical Applications of Artificial Intelligence and Radiomics in Neuro-Oncology Imaging","volume":"12","author":"Alksas","year":"2021","journal-title":"Insights Imaging"},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Ranjbarzadeh, R., Caputo, A., Tirkolaee, E.B., Jafarzadeh Ghoushchi, S., and Bendechache, M. (2023). Brain Tumor Segmentation of MRI Images: A Comprehensive Review on the Application of Artificial Intelligence Tools. Comput. Biol. Med., 152.","DOI":"10.1016\/j.compbiomed.2022.106405"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"6700","DOI":"10.1073\/pnas.1706459114","article-title":"Intraoperative Assessment of Tumor Margins during Glioma Resection by Desorption Electrospray Ionization-Mass Spectrometry","volume":"114","author":"Pirro","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3171\/2023.5.JNS23546","article-title":"Intraoperative in Vivo Confocal Laser Endomicroscopy Imaging at Glioma Margins: Can We Detect Tumor Infiltration?","volume":"140","author":"Xu","year":"2024","journal-title":"J. Neurosurg."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.neurol.2023.01.724","article-title":"Oncological and Functional Neurosurgery: Perspectives for the Decade Regarding Diffuse Gliomas","volume":"179","author":"Duffau","year":"2023","journal-title":"Rev. Neurol."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Bonosi, L., Marrone, S., Benigno, U.E., Buscemi, F., Musso, S., Porzio, M., Silven, M.P., Torregrossa, F., and Grasso, G. (2023). Maximal Safe Resection in Glioblastoma Surgery: A Systematic Review of Advanced Intraoperative Image-Guided Techniques. Brain Sci., 13.","DOI":"10.3390\/brainsci13020216"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1093\/neuros\/nyaa365","article-title":"Functional Outcomes and Health-Related Quality of Life Following Glioma Surgery","volume":"88","author":"Klein","year":"2021","journal-title":"Neurosurgery"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/24\/3890\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T05:15:12Z","timestamp":1765084512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/24\/3890"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":112,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["cancers17243890"],"URL":"https:\/\/doi.org\/10.3390\/cancers17243890","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}