Use of Bone Wax as a Marker in Cortex Glioma Resection under Limited Surgical Resources: First Experience and A Technical Note

Background: Differentiating tumor tissue from normal brain parenchyma during glial tumor resection can be highly challenging. In situations where surgical navigation systems are unavailable and the use of neuromonitoring is limited due to restricted resources, there is a need for affordable and practical alternatives.Aim: we describe a simple technique for delineating the resection margins of low-grade gliomas using bone wax as an intra-cavitary marker in conjunction with magnetic resonance imaging (MRI).Materials and Methods: During tumor resection, small sterile fragments of bone wax were placed within the resection cavity to serve as intra-cavitary fiducial markers. MRI was subsequently performed, allowing real-time visualization of the bone wax positions relative to the surrounding brain parenchyma.Results: Bone wax fiducials provided clear reference points for delineating tumor boundaries and assessing the extent of resection. Surgical margins were determined based on the spatial relationship between the bone wax markers and the residual enhancing tissue, facilitating accurate tumor removal in the absence of advanced neuronavigation systems. Tumor resection was carried out with careful preservation of eloquent cortical and subcortical regions, as identified by preoperative imaging and intraoperative anatomical landmarks.Conclusion: Bone wax represents a practical and cost-effective alternative in resource-limited settings, providing a simple method to minimize navigation system inaccuracies that may occur during surgery. It can be safely and effectively used in centers with limited technical resources.