The value of FDG-PET in image-guided neurological surgery

Objectives: 1. Review the present use of imaging data in neurosurgical procedures of the brain and spine 2. Review the use of FDG data in neurosurgical procedures of the brain and spine 3. Assess the added prospective value of FDG imaging in neurosurgical procedures of the brain and spine

Methods: A comprehensive search was performed using PubMed, Web of Sciences, and Google Scholar. This search included review articles, original studies (both prospective and retrospective), and abstracts. Once the studies were compiled, they were assessed on measures of quality such as study design, the number of subjects, and rigor applied statistical procedures.

Results: Neurosurgical practice has rapidly evolved to incorporate imaging data in ways previously unexplored. One such area involves the oncological operations of the brain and spine. Structural imaging data was originally used to plan procedures in the preoperational phase. Though structural imaging, by way of MRI and CT, are requisite in visualizing tumor location within the surrounding anatomy and planning a surgical route, the addition of molecular data is further advantageous. For instance, metabolic data from FDG-PET improves tumor differentiation from healthy brain tissues; thus, superior neuronavigation and tumor excision can be achieved. Further, the integration of PET data into other preprocedural and intraprocedural aspects of the surgical process has also been recently studied (e.g. the stereotactic planning of gamma knife radiosurgery or intraoperative use of MRI and augmented reality). A wide breadth of studies shows that the integration of PET data can maximize the value of said technological developments and the efficacy of said procedures especially in the context of oncological neurosurgery.

Conclusions: Neurological surgery is ever-evolving and new technologies continue to improve procedures and patient outcomes. Much of the prior emphasis on imaging in neurosurgery has been placed on structural imaging during preoperative evaluation; however, the literature indicates that functional imaging PET data is valuable when added to structural data. Moreover, recent technological advancements in the preoperative and intraoperative contexts have created further opportunities for the use of PET data to enhance image-guided neurosurgery.