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Cover Journal of Neurosurgery

Raman spectroscopy to differentiate between fresh tissue samples of glioma and normal brain: a comparison with 5-ALA–induced fluorescence-guided surgery

Laurent J. Livermore, Martin Isabelle, Ian M. Bell, Oliver Edgar, Natalie L. Voets, Richard Stacey, Olaf Ansorge, Claire Vallance, and Puneet Plaha

routine use in the 2018 National Institute for Health and Care Excellence (NICE) guidelines for the management of primary brain tumors. 6 There is evidence, however, that significant amounts of tumor extend beyond the visible fluorescence boundary, with between 25% and 65% false-negative rates reported in biopsies taken beyond the visible fluorescent margin. 7–11 Raman spectroscopy is a vibrational spectroscopy technique that has been applied to the identification of disease in various

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Cover Journal of Neurosurgery

Optimizing maximum resection of glioblastoma: Raman spectroscopy versus 5-aminolevulinic acid

Johannes Herta, Anna Cho, Thomas Roetzer-Pejrimovsky, Romana Höftberger, Wolfgang Marik, Gernot Kronreif, Tanja Peilnsteiner, Karl Rössler, and Stefan Wolfsberger

they require a trained user to interpret their results, these methods have not yet found their way into routine clinical practice. 20 , 21 A technology only recently brought into the neurosurgical theater is Raman spectroscopy (RS). It allows real-time discriminatory feedback of tumor tissue on a molecular level and is entity specific. Different types of spectroscopic systems have been introduced that allow assessment of tissue 1) prior to its resection with a single-point RS probe or an

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Cover Neurosurgical Focus

Improving the accuracy of brain tumor surgery via Raman-based technology

Todd Hollon, Spencer Lewis, Christian W. Freudiger, X. Sunney Xie, and Daniel A. Orringer

Raman images, discrimination of normal from neoplastic tissue using Raman technology, or the use of Raman imaging to interrogate a cellular process disrupted in primary brain tumor cells. After second-level screening, a total of 34 articles were included: 25 articles on Raman spectroscopy and 9 on coherent Raman scattering (CRS) microscopy. Spontaneous Raman Scattering: A Brief Overview Photons can be scattered by molecules in 2 ways. Most are scattered elastically, meaning that their

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Cover Neurosurgical Focus

Optical technologies for intraoperative neurosurgical guidance

Pablo A. Valdés, David W. Roberts, Fa-Ke Lu, PhD, and Alexandra Golby

prompted a collection of work worldwide utilizing this technology clinically to help improve the extent of resection. In addition to this initial implementation of fluorescence technology and biomarker use in major trials to date, multiple additional optical tools or technologies are beginning to enter the clinical arena, including diffuse reflectance spectroscopy and imaging, optical coherence tomography (OCT), Raman spectroscopy, and quantitative methods, including quantitative fluorescence

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Cover Neurosurgical Focus: Video

Contemporary intraoperative visualization for GBM with use of exoscope, 5-ALA fluorescence-guided surgery and tractography

Alexander J. Schupper, Jorge A. Roa, and Constantinos G. Hadjipanayis

Maximal safe resection is the primary goal of glioma surgery. By incorporating improved intraoperative visualization with the 3D exoscope combined with 5-ALA fluorescence, in addition to neuronavigation and diffusion tensor imaging (DTI) fiber tracking, the safety of resection of tumors in eloquent brain regions can be maximized. This video highlights some of the various intraoperative adjuncts used in brain tumor surgery for high-grade glioma.

In this case, the authors highlight the resection of a left posterior temporal lobe high-grade glioma in a 33-year-old patient, who initially presented with seizures, word-finding difficulty, and right-sided weakness. They demonstrate the multiple surgical adjuncts used both before and during surgical resection, and how multiple adjuncts can be effectively orchestrated to make surgery in eloquent brain areas safer for patients. Patient consent was obtained for publication.

The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21174

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Cover Neurosurgical Focus

Introduction: Utility of intraoperative imaging

Rudolf Fahlbusch, Alexandra Golby, Francesco Prada, and Gabriel Zada

modalities such as Raman spectroscopy and confocal microscopy. Throughout the issue we also tried to stress the pivotal role of cooperation among neurosurgeons, radiologists, and engineers, carefully balancing clinical and practical needs. We were pleased to receive 56 submissions from around the world, all of outstanding quality. Limited to 16 articles and 2 editorials, we were forced to make difficult choices. We have selected articles encompassing all major aspects and current state

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Cover Journal of Neurosurgery

Novel approaches to targeting gliomas at the leading/cutting edge

Alexander J. Schupper and Constantinos G. Hadjipanayis

growth factor receptor expressed by GBMs may provide more targeted FGS especially at the infiltrative tumor margin. 35 Additional conjugated antibodies and analogs are being developed; however, there are no current clinical data to support their use. 22 Raman Spectroscopy While FGS offers detection of tumor cells beyond the area of contrast enhancement on MRI, Raman spectroscopy can provide visualization and characterization of microscopic cytoarchitecture in a label-free manner. During

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Cover Neurosurgical Focus

The role of optical spectroscopy in epilepsy surgery in children

Sanjiv Bhatia, John Ragheb, Mahlon Johnson, Sanghoon Oh, David I. Sandberg, and Wei-Chiang Lin

and injuries. 4 , 35 , 38 , 42 , 55 There are 3 optical spectroscopy types that are used frequently in biomedicine to monitor light-tissue interaction and therefore to perform in vivo tissue characterization: diffuse reflectance spectroscopy, 6 , 7 , 9 , 12 , 13 , 19 , 20 , 25 , 30 , 34 , 39 , 48 , 50 , 54 , 56–58 fluorescence spectroscopy, 26 , 27 and Raman spectroscopy. 2 , 11 , 15 , 16 , 31 , 33 Each of these spectroscopy types targets a particular type of light-tissue interaction and a

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Cover Journal of Neurosurgery

Identifying brain tumors by differential mobility spectrometry analysis of diathermy smoke

Ilkka Haapala, Markus Karjalainen, Anton Kontunen, Antti Vehkaoja, Kristiina Nordfors, Hannu Haapasalo, Joonas Haapasalo, Niku Oksala, and Antti Roine

tissue. 3 Raman spectroscopy is a modality that gives spectral tissue characteristics based on molecular signatures resulting from inelastic scattering of incident light. The resulting spectrum provides a fingerprint by which different molecular species can be identified. Raman spectroscopy reached sensitivity of 93% and specificity of 91% in binary classification when used for WHO grades II–IV brain tumor detection. 8 The rapid evaporative ionization mass spectrometry (REIMS) setup, developed by the

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Cover Journal of Neurosurgery

Treatment and outcomes of IDH1-mutant gliomas in elderly patients

Alexandra M. Giantini-Larsen, Zaki Abou-Mrad, Kenny K. Yu, Anne S. Reiner, Tejus A. Bale, Viviane Tabar, and Evan D. Bander

chemotherapy regimen—balancing quality of life and the side-effect profile—in IDHmt gliomas, particularly low-grade gliomas. 33 , 34 This is particularly relevant for the older IDHmt population. The development of intraoperative diagnostic adjuvants such as Raman spectroscopy may provide real-time histological and molecular analysis including IDH mutation status with sufficient accuracy and precision; 35 – 37 such biomarkers could potentially be used to guide surgical decision-making in the operating