Surgical management for supratentorial astrocytic tumors

To compare the surgical treatment of supratentorial astrocytic tumors, vari ous methods were performed by the same surgeon. Removal of the tumor was pe rformed using stereotactic open surgery, the fluorescein surgical microscop e, and a frameless stereotactic system, and these methods were compared. Th e method using the stereotactic technique was useful because there was no d isturbance by the shifting of the brain during the operation. However, its limitation was that only points can be marked. The fiuorescein surgical mic roscope was very useful in the cases where neuroradiological images were en hanced by the contrast medium, but deep lesions could not be identified fro m the brain surface. This method could not be used, either, in the case of images that were not enhanced. By the method using the frameless stereotact ic system, identification of tumors including deep lesions was possible fro m every direction, but the problems were the mobility of the registered ski n and the shifting of the brain during the operation. On the basis of these results, the combined method of the fluorescein surgical microscope and th e frameless stereotactic system appeared to be useful when neuroradiologica l images of lesions were enhanced because these methods were complementary towards each other, and the frameless stereotactic system supplemented by t he stereotactic open surgery technique (such as leaving a marker in deep le sions just before the start of microsurgery) seemed useful when images coul d not be enhanced.