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Paper text:
infrared thermography ( irt ) has a potential for wide application in the experimental and clinical medicine [ 1 , 2 ] .
the reliability of the method in surgery of malignant brain tumors , however , is not well established . here
we report on the intraoperative use of this technique in a single patient with newly diagnosed glioblastoma multiforme ( gbm ) .
an 86-year - old female was admitted to the clinic with a 2-month history of slowly progressing left - sided paresis .
neuroimaging studies demonstrated an irregular space - occupying process consistent with a malignant glioma in the right fronto - temporo - insular region ( fig .
an elective surgical intervention was performed by using 5-aminolevulinic acid fluorescence ( gliolan ; blue 400 , opmi ) and intraoperative irt brain mapping ( lwir , 1.25 mrad ifov , 0.05c netd ) .
however , the ultraviolet light exposure revealed a moderate fluorescence in the region of the silvian fissure ( fig .
2b ) , and the irt observation demonstrated a significantly colder area ( t 1.01c ) in the limited field of the middle frontal gyrus , well corresponding to the epicenter of the lesion ( fig . 2c ) .
the underlying tumor was approached directly only by using the fused brain topography and thermal imaging data .
a partial excision of the lesion was performed , and the histological result was gbm ( fig .
no additional neurological deficit appeared on the next day after the intervention , and the computed tomography scan of the patient was rated as postoperatively normal .
the surgical approach in cases with newly diagnosed gbm depends on the anatomical localization of the tumor and the neurological status of the patient .
choosing the most direct and safest way to access the lesion is one of the major tasks of the operator during the intervention . in order to facilitate the work of the neurosurgeon ,
a number of different imaging and electrophysiological procedures have been developed , each of them , however , presenting one or more significant and well - known disadvantages [ 4 , 5 ] . in this regard
, the ideal technique should be safe for the patient , fast and easy to perform , with a high level of sensitivity and specificity .
it is a non - contact diagnostic tool able to provide real - time functional and structural information of the patient 's brain .
the use of this technique in surgery of malignant brain tumors has been previously reported . nevertheless , the number of cases is generally small   and some of the expectations may not be warranted based on the experience available so far .
intrinsic malignant gliomas have a lower temperature in comparison with the surrounding normal brain matter , and this finding has been confirmed in both animal and human models [ 9 , 10 ] .
the two major factors that may contribute to hypothermia in these cases are ( 1 ) decreased metabolism of the surrounding and overlying tissues , caused by the perifocal edema and ( 2 ) low density in tumor microvessels , due to presence of concomitant necrosis . in our case ,
irt mapping was able to detect a significantly colder area in the limited field of the brain surface , well corresponding to the cortical epicenter of the underlying lesion .
intraoperative 5-aminolevulinic acid fluorescence is a well - recognized method for achieving gross - total resection in cases with newly diagnosed gbm . in some instances ,
even when the cerebral surface appears seemingly normal , switching to blue excitation light may allow discrimination of subcortical tumor extensions , providing a valuable guide for initial approach . by using this method in our patient ,
moderate fluorescence was observed only in the region of the sylvian fissure , which is , however , an inadvisable point for entering into the lesion in this particular case .
further studies with a large number of patients are needed to prove the reliability of this method in gbm surgery .
infrared thermography ( irt ) is a real - time non - contact diagnostic tool with a broad potential for neurosurgical applications . 
 here we describe the intraoperative use of this technique in a single patient with newly diagnosed glioblastoma multiforme ( gbm ) . 
 an 86-year - old female was admitted in the clinic with a 2-month history of slowly progressing left - sided paresis . 
 neuroimaging studies demonstrated an irregular space - occupying process consistent with a malignant glioma in the right fronto - temporo - insular region . 
 an elective surgical intervention was performed by using 5-aminolevulinic acid fluorescence ( blue 400 , opmi ) and intraoperative irt brain mapping ( lwir , 1.25 mrad ifov , 0.05c netd ) . 
 after dura opening , the cerebral surface appeared inconspicuous . 
 however , irt revealed a significantly colder area ( t 1.01c ) , well corresponding to the cortical epicenter of the lesion . 
 the underlying tumor was partially excised and the histological result was gbm . 
 intraoperative irt seems to be a useful technique for subcortical convexity brain tumor localization . 
 further studies with a large number of patients are needed to prove the reliability of this method in gbm surgery .