Next Frontiers in Surgical Management

The surgical management of tumors of the central nervous system has been pursuing new therapeutic and clinical needs upon the push of the recent developments of the molecular era, advanced imaging and radiomics, and immunomodulatory/targeted therapies. Three cornerstones can be considered when it comes to surgical treatment of intracranial malignant lesions: (1) oncological radicality, (2) the full preservation of the neurological functions, and (3) the achievement of a proper histological and molecular diagnosis. In this direction, one of the major questions is to understand if there is already space for a supra-total resection. Important perspectives are connected with information-guided brain surgery and through the maximization of the extent of resection, enhancing the detection of the glioma edge. Are already available and applicable new intraoperative tools, such as intraoperative ultrasound (ioUS) and intraoperative MRI (iMRI), fluorescence, Raman spectroscopy, stimulated Raman scattering (SRS), and stimulated Raman histology (SRH). Together with novel therapeutic approaches, that will be discussed in this chapter, will be also considered the increasing relevance of a more favorable functional preservation for the quality of life and survival.