Decision analysis with integration of the intraoperative visible information from multimodal sources for the surgical decision-making

During operative procedure surgeons are obliged to make important clinical decisions constantly. In the past this process was mainly based on the observation of the surgical field and was significantly dependent on the individual experience. Since current clinical data demonstrate profound impact of more aggressive brain tumor resection on patient’s prognosis, novel methods for optimization of the surgical decision-making seem necessary. It can be attained by application of the real-time integrated analysis and visualization of the various intraoperative data related to imaging, functional monitoring, and histopathological investigation, which constitutes the basis of the ”information-guided surgery” concept opening new perspectives for innovative minimally invasive treatment of the various neurosurgical diseases. Integrated analysis of the various intraoperative data from multiple sources may contribute significantly to reliability of surgical decisions and profoundly improve their preciseness. However, this process is rather complex. Technically, there is no straightforward way for judgements on patient response during awake craniotomy, positivity of 5-ALA-induced tissue fluorescence, presence of the navigational error caused by the brain shift, or determination of the threshold of MEP decline. On the other hand, in tumors located within or in close vicinity to eloquent cerebral structures the surgeon frequently encounters a dilemma between anatomical and functional data, which requires prioritizing of the available information during complicated choice between more aggressive tumor resection and preservation of the functionally important neuronal tissue. Availability of the histopathological characteristics of the resected tissue and other kinds of information may be rather helpful for critical surgical decision-making. Herein we describe our concept of the information-guided surgery of brain tumors, present the results of its clinical application, and discuss perspectives of its further development in the nearest future.