Image-Guided Surgery For Brain Tumours

Posted On Dec 28, 2021

Dr. Raghunathan Natrajan

Consultant - Neurosurgery

Manipal Hospitals-Salem

Best Neurosurgery Hospital in Salem


The incidence of CNS tumours in India ranges from 5-10 per 100,000 population. Surgery is one of the Treatment modalities for managing brain tumours. Complete resection with minimum complications improves the outcomes. Image-guided brain tumour surgery is a boon in the neurosurgical theatre to achieve maximal safe resection of brain tumours with minimal neurological morbidity.

Image-Guided Surgery For Brain Tumours

Image-guided brain tumour surgery is an advanced treatment technique for removing brain tumours. This advancement evolved due to the significant intervention of computers in neurosurgery that the scientists anticipated way back in 2000. Image-guided surgery involves using images through the electromagnetic field or cameras that assist the surgeons in performing the surgery. 

The imaging technique helps during the surgery, and it also assists in planning the safest path and trajectory route during surgery for brain tumours. Image-guided surgery is also known as surgical navigation, stereotaxy, computer-assisted surgery, stereotactic navigation, and navigated surgery.

Besides brain tumours, image-guided surgery also helps manage epilepsy, Parkinson's disease, essential tremors, and arteriovenous malformations. The doctor may also combine image-guided surgery and awake brain surgery in some cases.

You can get image-guided surgery for brain tumors in Salem at Manipal Hospital equipped with top-class technologies and equipment and have one of the best neurosurgeon in Salem who has extensive experience in treating common to rare brain problems.

Use Of Imaging In Image-Guided Surgery

Imaging forms the basics of image-guided surgery. The conventional neuronavigation system had several challenges. One of them was the lower navigational accuracy. In addition, the traditional method of neuronavigation did not account for the brain shift during surgery. It may occur due to cerebrospinal fluid loss and cerebral oedema. Therefore, several advanced imaging techniques are used to make the surgery safer. Some of the imaging techniques are:

  • Intraoperative MRI (iMRI): iMRI significantly increases the outcome of brain tumour surgery because of real-time assessment of residual tumor, in maximizing tumor removal and improving overall survival(OS) and progression-free survival (PFS) of these patients. IMRI creates optimal quality, real-time images that assist the surgeon in simultaneously assessing and removing the tumour.

  • Intraoperative Ultrasound (iUS): Widely available, Cost-effective tool in brain tumor surgery. It was a 9KHZ-14KHZ ultrasound probe to see the tumor during surgery from the surface. Brain tumor will be visualized as the hyperechoic lesion, and during tumour removal, IUS helps in visualizing the residual tumor and thus help in total tumour removal. The technique creates 2D or 3D images. The surgeons commonly combine the iUS and neuronavigation technology. However, ultrasound did not provide clear images of the deep-seated tumour that may limit its use in image-guided brain tumour surgery.

  • Intraoperative optical fluorescence imaging: This technique uses the principle of selective trapping of metabolites inside the tumour cells, which has fluorescent properties. This fluorescence can be visualized with a neurosurgical microscope, filled with appropriate light filters and corresponding wavelengths. This technique allows the surgeons tissues, reducing postoperative neurological complications. USFDA had approved 5-aminolevulinic acid (5-ALA) with indocyanine green (ICG) and protoporphyrin IX (PpIX) as contrasting agents in optical fluorescence imaging.

 Advantages Of Image-Guided Surgery

Following are some of the advantages of image-guided surgery:

  • Minimally invasive surgery reduces healing time, stays days in hospitals, and complications.

  • Excellent control over the instruments to avoid damage to healthy tissues

  • Preplanning allows highly predictable outcomes

  • It helps preserve critical brain functions

  • Positive outcomes in performing complex brain tumour surgeries

  • Reduces errors during the surgery

  • Lowers the chances of revision surgeries

Steps Of Image-Guided Surgery

The surgeon performs the image-guided surgery through the following steps:

Planning: The doctor uploads the images on the image guidance system. The system creates a 3D model that accurately shows the brain, skull, tumour and other critical structures. Through the 3D model, the surgeon outlines the area of surgery while preserving the healthy tissues. 

Preparing the patient: After planning the surgery, the staff brings the patient to the surgery room. First, the doctor gives anaesthesia to the patient. Next, the doctor shaves and cleans the head area to make an incision. Finally, the doctor immobilizes the head of the patient to make it stable throughout the procedure.

Registration of patient: The doctor registers the skull of the patients on the navigation system. The system aligns the skull and other structures with the pre-loaded images of the patient. The image-guided system then tracks the surgical instrument and brain in real-time throughout the surgery.

Removing brain tumour: 

  • Image guiding techniques helps to plan the scalp incision exactly over the tumour and thus smaller incision, which in turn helps in wound healing and shorter hospital stay.

  • After the scalp incision step, navigation assists in tailoring the skull opening size to the minimum, hence a shorter duration of surgery.

  • Once the brain tumor is reached, intra-operative fluorescence-guided surgery using 5 – ALA / Fluorescein permits the visualization of malignant tumor tissue from the normal brain and supports the neurosurgeon with real-time guidance for differentiating tumour independent of Neuronavigation & brain shift. Intraoperative US/MRI provides the estimate of the residual tumour as the tumor removal goes on and aid the surgeon to remove the tumor completely

Closure: After achieving the aim, which can be complete or partial tumour removal, the doctor closes the incision and secure the place with a bandage. 

Recovery After Image-Guided Surgery

After the surgery, the staff shifts the patient to the recovery room. Image-guided surgery for the tumour is minimally invasive. Thus, the patient has a fast recovery. The doctor discharges the patients within a few days after the procedure. However, the recovery depends upon the type of tumour, the age of the patient, and his health. The recovery also depends upon the amount of tumour removal that affects the patient's overall health.

Don’t delay, visit the best Neurosurgery Hospital in Salem if you have any problems related to the brain or spinal cord.


Dr. Raghunathan Natrajan

Consultant - Neurosurgery

Manipal Hospital, Salem

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