Gliomas are tumors that occur in the neural ectoderm, so they are also known as neuroectodermal tumors or neuroepithelial tumors. The tumors originate from neural mesenchymal cells, i.e., neuroglia, ventricular canal membrane, choroid plexus epithelium, and neuroparenchymal cells, i.e., neurons. The incidence of neuroglial tumor tumors is approximately 100 times higher than that of neuronal cell tumors. Among the various types of glial tumors, astrocytomas are the most common (75%), followed by oligodendroglial cell tumors (8.8%), ventriculo-parenchymal cell tumors (7.3%), medulloblastomas (3%), and the rest are less than 1%, respectively. Since Virshow applied the term glioma to describe primary tumors in the brain, it refers to tumors originating throughout the neuroepithelial tissue and including all types of glial cells and neurons. These tumors are collectively referred to as gliomas in neurosurgical clinics and neuroimaging, i.e., gliomas in a broad sense. Feng Fuqiang, Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University The individualized treatment of glioma surgery is mainly reflected in two points: First, it is important to cut more or less; surgery is the most favorable means and tool for the treatment of cerebral gliomas, but how to achieve tumor resection of more than 95% and to protect the brain function is an issue that needs to be seriously considered and studied in our clinic. In MRIT1 image, resection of annular enhancement area outside the 2cm can achieve resection of more than 98%, and resection of annular enhancement area of single storage only resects 92% of the tumor, this method of resection is harmful and not beneficial, not only can’t improve the survival period of the patients, on the contrary, it activates rapidly the quiescent (G0) tumor cells outside the annular enhancement area to enter into the G1 stage quickly, and the tumor grows up rapidly during the period of hospitalization after the surgery of some patients. grows up. Therefore, extended resection of malignant gliomas is beneficial to the prolongation of patient survival. Low-grade gliomas, especially WHO grade I gliomas, can theoretically be cured by surgical resection, and extended resection must be done under the premise of guaranteeing function in order to improve the cure rate. Comparatively speaking, WHO grade III and IV tumors, due to their poor prognosis and short natural survival cycle, the maximum safe resection should be done under the premise of guaranteeing their function, and guaranteeing postoperative quality of life should be taken more seriously. Secondly, it is critical to be able to cut. Gliomas located in functional areas such as motor area, sensory area, basal ganglia area, brainstem and other parts of the brain are infiltrated by normal tissues and have unclear boundaries, so random resection or extended resection in such “land and gold” areas will inevitably lead to irreparable neurological deficits, resulting in hemiparesis, aphasia and other symptoms, causing serious deterioration of the quality of life of the patients. The quality of life of the patients will be seriously reduced, which will bring endless burdens to the society and families. Therefore, at this stage, there are a lot of new technologies and new operations to pay attention to glioma in the functional area. Before surgery, patients can identify the benign and malignant grade of the tumor, show the relationship between the tumor and the white matter fibers, determine the language and sensory-motor areas, and combine with neuronavigation to anchor the surgical work by using the existing functional brain imaging techniques, such as magnetoencephalography (MEG), enhancement MRI, positron emission tomography (PET), blood-oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI), and diffusion tensor imaging (DTI). neuronavigation to anchor the surgical working target area. During the operation, the following techniques are used for precise guidance. 1, intraoperative new ultrasound technology. Accurate and safe implementation of complete glioma resection during glioma surgical treatment intraoperatively depends on precise identification of glioma boundaries. The biological characteristics of gliomas, especially high-grade gliomas with highly infiltrative growth, make it difficult for conventional ultrasound to identify the tumor boundary with the peritumoral band of the same edematous tissue. Even with the use of high-resolution intraoperative ultrasound, difficulties remain. The solution to this problem requires the introduction of new ultrasound techniques and tools, according to the tumor pathology and histological changes, such as tumor angiogenesis (angiogenesis), angiogenesis caused by the increase in microvessels and neovascular structural abnormalities in gliomas can be expected to serve as a diagnostic technique of functional ultrasound imaging application of the pathological and anatomical basis. Power Doppler imaging (PDU), which is highly sensitive to low-velocity flow and is not affected by the direction of flow, can show abundant low-velocity flow signals within the angiogenesis-rich foci of gliomas, which are distinctly different from those in the peri-tumor edematous zone. The significant difference in the level of angiogenesis between high-grade gliomas and peritumoral edematous tissues is a reliable pathological basis for the use of intraoperative energy Doppler imaging (PDU). In the resection of functional subcortical gliomas, PDU can help to select a safe surgical approach, accurately determine the residual tumor and its relationship with the functional cortex, and has a high value in selecting and establishing the boundaries between tumor resection and protection of the functional area, as well as controlling the extent of tumor resection and protecting the functional cortical structures.PDU can be used to further accurately, reliably, and regionally differentiate high-grade gliomas from peritumoral edema. The application of PDU can further accurately and reliably distinguish high-grade gliomas from peritumoral edema, but the specific application techniques need to be further improved. The application of new ultrasound technology to improve the ability of ultrasound in glioma resection to identify the boundary of the tumor and its precise control of the resection range has an important application value. 2. Intraoperative neuronavigation technology. The neuronavigation system combines the patient’s imaging data and the patient’s intraoperative position through the computer, accurately displays the three-dimensional spatial position of intracranial tumors and the important neural and vascular structures in the vicinity, and through the localization device, it can accurately locate any point in the space, and also can achieve real-time tracking. Its precise localization function not only helps to design the surgical route, but also can guide the intraoperative operation in real time and objectively, so that the surgery can achieve a more accurate and delicate purpose. Neuroimaging navigation technology under brain functional imaging is to integrate the three-dimensional information of lesion and cranial brain obtained by MRI with the relationship between tumor and functional area obtained by functional imaging, which can not only increase the scope of resection and improve the surgical precision, but also reduce or avoid the damage to the function. 3.Intraoperative MRI imaging technology. Conventional preoperative imaging results (e.g., conventional MRI, CT, etc.) can only show anatomical images, but not functional brain structures such as the language area or the arcuate fasciculus. Magnetoencephalography (MEG) can localize the cortex of the speech area, but it cannot show the white matter fiber tracts, and the equipment is not widely available. Preoperative cortical electrode embedding and stimulation requires craniotomy, which is difficult for patients to accept. Intraoperative cortical electrical stimulation, although currently the “gold standard” for cortical functional localization, has the disadvantages of more complex operation, patients need to be awakened during the operation, higher requirements for anesthesia and surgery, and it cannot provide functional area localization information for preoperative planning. Based on the above difficulties, the design of the surgical approach, the localization of the tumor and the estimation of the resection range, as well as the intraoperative protection of the speech-related functional structures have long relied on the surgeon’s experience and judgment, and there is a lack of scientific and objective tests and judgment indicators. If the lesion shows infiltrative growth (e.g. glioma), lacks visible anatomical boundaries with the surrounding brain tissues, or the normal anatomical structures have been destroyed, it is difficult for even experienced surgeons to accurately judge the boundary of the lesion with the aid of a surgical microscope, and even more so, it is not possible to distinguish the language-related cortical layers or white matter fiber bundles, which makes it difficult to maximize the resection of the lesion and at the same time protect the important language-related functional structures. The clinical application of functional neuronavigation solves this problem. With the help of fMRI-BOLD and DTI, the main cortical areas of the language area (Broca’s and Wernicke’s areas) and the arcuate fasciculus in between can be reconstructed and projected under the operating microscope to “visualize” the important language-related structures, thus allowing the operator to intuitively avoid damaging these important structures, This allows the surgeon to intuitively and accurately avoid damaging these important structures, which significantly improves surgical efficiency. Together with the high-field intensity iMRI system, the system effectively and precisely solves the problem of “brain displacement” error that exists in conventional neurosurgical navigation. The intraoperative scan can show the important functional structures of the brain after displacement, and if the intraoperative scan finds residual tumors, the tumor can be enlarged and resected under the guidance of navigation after updating the navigation image. This will help to increase the extent of tumor resection, reduce the risk of damage to vital functional areas, decrease the rate of surgical disability, improve the quality of postoperative survival and ultimately prolong the length of postoperative survival of patients. However, the use of intraoperative MRI is time-consuming and expensive, so it is difficult to popularize its application. 4, Intraoperative wake-up anesthesia technology. Intraoperative awakening anesthesia refers to the anesthesia technology that requires patients to complete certain nerve tests and command actions under awake state at a certain stage of the surgical process, mainly including local anesthesia combined with sedation or real intraoperative awakening general anesthesia technology. Patients in the awake state to accept the brain functional area surgery, it is convenient for the operator to understand the patient’s speech, movement and other functional changes at any time, which can make the operator in the removal of the tumor can be observed in time to see whether there are patients with neurological damage occurs, to avoid serious damage to the brain functional area tissues. Therefore, intraoperative arousal anesthesia can ensure complete resection of the tumor and guarantee that the functional brain area will not be damaged. 5. Intraoperative neurophysiological monitoring technology. The purpose of intraoperative neuroelectrophysiological monitoring is to provide timely feedback to the surgeon and anesthesiologist on the changes of intraoperative neurological integrity through electrophysiological technology, which can guide the operator to identify the target nerves, neurological functional areas and neurological conduction pathways of the operative field, and then take preventive measures in time, so as to avoid irreversible damages, reduce the occurrence of neurological dysfunctions or deficiencies in the postoperative period, and improve the patients’ postoperative quality of life. Among them, the application of somatosensory evoked potential phase inversion technology, myogenic motor evoked potentials and intraoperative direct electrical stimulation can accurately realize intraoperative brain function localization. Due to the occupying effect, the tumor tissue often infiltrates and pushes the adjacent brain functional areas, or causes functional remodeling, and it is often impossible to accurately determine the positional relationship between the tumor and the functional areas during the operation, which limits the extent of tumor resection and the preservation of neurological function. Intraoperative direct electrical stimulation can locate and monitor the functional tissues invaded by or adjacent to the tumor, thus avoiding aphasia, hemiparesis, and sensory deficits in the postoperative period and improving the patients’ long-term quality of life. Using intraoperative direct electrical stimulation technology, not only intraoperative cortical functional localization, but also functional monitoring and tracking of subcortical nerve conduction bundles are feasible, which is the gold standard for the localization of cerebral functional areas at present. 6. Intraoperative tumor coloration technology. It is a recent hotspot of research, which has the features of accurate positioning, fast, easy application, high sensitivity and specificity, etc. Dufner et al. cultivated tumor cells and nerve cells with 5-aminolevulinic acid (5-ALA), and used the difference of fluorescence intensity to distinguish tumor cells from nerve cells. Currently there are two color development techniques are more mature, one is the sodium fluorescein method, using the tumor to destroy the blood-brain barrier, fluorescein leakage out of the unhealthy blood vessel wall, the application of laser activation of fluorescein, through the special grating, you can determine the boundary of the tumor; the other is the non-sodium fluorescein pathway that is the 5-ALA method, to activate the fluorescent protoporphyrin in vivo, a process which requires the participation of the enzyme of the biosynthesis pathway of the enzyme ferroheme, 5 a ALA fluorescence coloring technology is currently the most mature coloring technology, the specificity of 5-ALA is higher than that of sodium fluorescein. However, 5-ALA is more phototoxic, and patients need to avoid light for 24 h. On the contrary, fluorescein sodium method is easy to apply, economical, and has a low complication rate, which can be widely promoted in the clinic if it can overcome the shortcomings of its low specificity. Therefore, in clinical work, when performing surgical resection of glioma, it is necessary to read the film carefully, examine the body carefully, fully grasp the principle of resection, apply the current technical means, and master the resection proportion, so that every patient can benefit from the personalized treatment means.