Anatomical landmarks during high-magnification microsurgery for a safe and effective resection of high-grade gliomas: how I do it

Background: Gross total resection, when possible, is the first crucial treatment for high-grade gliomas, as it has been demonstrated to be associated with longer survival. Different intraoperative tools, such as neuronavigation, fluorescent agents, and intra-operative ultrasound, have been developed to help neurosurgeons to extend the resection. Methods: We describe the high-magnification microsurgery technique used during the first surgical removal for high-grade gliomas. We illustrate the key anatomical “markers” of normal brain parenchyma, which guide the surgery. Conclusion: High-magnification microsurgery is an anatomically based approach that allows the identification of key anatomical “markers” of normal brain parenchyma in order to resect high-grade gliomas safely and effectively.