Maximum brain tumor resection

Maximum safe brain tumor resection

  • Clinical challenge
  • ZEISS solution
  • Peer Insights

Maximizing tumor resection while preserving eloquent areas

Clinical challenge

Finding the balance between preserving functional areas and extending resection during brain tumor surgery is a challenge even for experienced neurosurgeons. Therefore, intraoperative information is critical to be able to make the right decision at the right time.

Andreas Raabe, MD

The main question is: Is there still tumor? […] And here maximum safe resection is the principle because we cannot cure them by surgery and still the extent of resection correlates with survival. […] It is not only the extent of resection but also the maintenance and the preservation of function.

Andreas Raabe, MD, Professor, Director and Head Physician

Department of Neurosurgery, University Bern, Switzerland

Clinical challenges in brain tumor treatment

  • Visualization of fluorescence


    Precise identification of tumor areas is crucial, particularly in the case of infiltrative gliomas.1
    Therefore, the foundation of a safe surgery is the multifaceted visualization of the target region and the surrounding eloquent tissue.2,3

  • Check brain tumor


    In vivo cellular imaging in real-time remains a challenge in neurosurgery. It is practically impossible to remove every glioma cell surgically. Increasing the precision of glioma removal with more accurate margin delineation predicts better treatment outcomes.4,5

  • Treating brain tumors


    Radiotherapy in the brain is normally done several weeks after the surgical tumor removal which enables potential residual tumor cells to regrow by then.6 In addition, conventional radiotherapy today has a certain risk of irradiation scattering which can lead to radiation necrosis of eloquent tissue and result in neurocognitive failures.7,8

ZEISS Tumor Workflow

The ZEISS Tumor Workflow9 combines three leading technologies from ZEISS: Advanced surgical visualization, in vivo pathology, and intraoperative radiotherapy. Thereby, ZEISS supports multidisciplinary teams, including neurosurgeons, neuropathologists, and radiation oncologists, over several steps of the surgical workflow in delivering brain tumor treatment.

  • 1

    Belykh E, et al. Progress in confocal laser endomicroscopy for neurosurgery and technical nuances for brain tumor imaging with fluorescein. Front Oncol 2019;9:554.

  • 2

    Schebesch K-M, et al. Clinical Benefits of Combining Different Visualization Modalities in Neurosurgery. Frontiers in Surgery 2019;6:56. DOI:10.3389/fsurg.2019.00056

  • 3

    The application image of ZEISS BLUE 400 is courtesy of Prof. Dr. Walter Stummer, University Clinic, Munich, Germany.

  • 4

    Belykh, E. et al. Blood-Brain Barrier, Blood-Brain Tumor Barrier, and Fluorescence-Guided Neurosurgical Oncology: Delivering Optical Labels to Brain Tumors. Fron Oncol 2020;10;739. DOI=10.3389/fonc.2020.00739

  • 5

    The ZEISS CONVIVO ex vivo confocal image is courtesy of Dr. med. Jürgen Schlegel, Technical University Munich, Germany.

  • 6

    Cifarelli, C.P., etal. (2019). Intraoperative radiotherapy (IORT) for surgically resected brain metastases: Local control and dosimetric analysis. Journal of Global Oncology, 5(suppl1), 114

  • 7

    Vargo, J.A., et al. (2018). Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery. Journal of Neuro-Oncology, 140(2), 413–420.

  • 8

    The application image is courtesy of Dr. med. Stefanie Brehmer, Mannheim Medical Faculty at University of Heidelberg, Germany.

  • 9

    ZEISS Tumor Workflow is a concept that includes ZEISS KINEVO 900, ZEISS CONVIVO and ZEISS INTRABEAM 600.