Open brain tumor resection using MRI FLAIR method

Since brain tumors grow in the closed space of the skull, it is necessary to pay close attention to adhesions to the surrounding brain and treatment of infiltration sites.
To perform a safe and reliable brain tumorectomy,
(1) Consider the safest and easiest approach to surgery before surgery,
(2) To know exactly where the tumor is currently being removed during surgery,
(3) At the time of tumor resection, efforts should be made to preserve the function of the cerebral blood vessels and cranial nerves within or in contact with the tumor.
are particularly important.
After surgery, it is important to (4) examine the excised tumor by pathology, and carefully monitor the progress of tumors that can be predicted to recur easily.


From that point of view, I have devised a variety of methods for craniotomy to remove tumors, and have performed complete resections while preserving function, even for tumors that are difficult to remove.
I would like to introduce the contents that have been published in papers and conferences so far.

Regarding ①
In the MRI FLAIR method (first liquid acquisition inversion recovery sequence), in T2WI (T2 weighted imaging), which is commonly performed in MRI, the cerebral edema around the brain tumor remains white, and only the water becomes no signal (it turns black like the air). It is an imaging method that changes and displays.
The greatest advantage of the FLAIR craniotomy is that it is possible to know before surgery whether there is even a small amount of cerebrospinal fluid between the brain tumor and the surrounding brain. If there is a gap, it can be used to safely dissect the tumor between the brains.
Since 1994, when the FLAIR method was introduced to Japan, I have actually used the FLAIR method in 34 cases of craniotomy for meningioma, malignant glioma, epithelioid tumor, and acoustic schwannoma, and found it to be very useful. I was quick to report something. Although this method was announced ahead of the rest of the world, it is now common. In particular, it was difficult to differentiate between epithelioid tumors and arachnoid cysts until the FLAIR method was introduced, but we also reported that the FLAIR method facilitates the differentiation (currently, MRI DWI can also be used).
(Craniotomy Tumor Extraction Using FLAIR Technique: Abstract)
full text(Neurosurgery 1997)FLAIR
At Mitsui Memorial Hospital Neurosurgery, we effectively use the FLAIR method to perform craniotomy tumor resection.

Regarding ①, regarding surgery for deep brain tumors, which is another point
⇒ Please see "Her knowledge of brain tumor treatment Part 3 Tumor removal using sulcus".
Regarding ②③
⇒ See "Knowing the treatment of brain tumors Part 2 Intraoperative navigation and intraoperative monitoring".
Regarding ④
⇒ Please see "Knowing the treatment of brain tumors Part 4 Pathology of postoperative recurrence of brain tumors".