Awake surgery for WHO Grade II gliomas within “noneloquent” areas in the left dominant hemisphere: toward a “supratotal” resection

Yordanova, Yordanka; Moritz‐Gasser, Sylvie; Duffau, Hugues

doi:10.3171/2011.3.jns101333

Cited by 318 publications

(220 citation statements)

References 38 publications

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“…2,29,49,50,53 Indeed, despite the lack of Class I evidence demonstrating that DLGG surgery improved survival, Jakola et al 29 recently investigated survival in population-based parallel cohorts of patients with DLGGs from 2 Norwegian university hospitals with different surgical treatment strategies. They demonstrated that treatment at a center that favored early resection was associated with better overall survival (median survival not reached) than treat- Object.…”

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confidence: 99%

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Chan-Seng¹,

Moritz‐Gasser

Duffau

2014

JNS

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P atients with diffuse low-grade glioma ([DLGG]; that is, Grade II glioma according the WHO classification) tend to live many years after diagnosis, with surgery helping to further extend survival time. 2,29,49,50,53 Indeed, despite the lack of Class I evidence demonstrating that DLGG surgery improved survival, Jakola et al. 29 recently investigated survival in population-based parallel cohorts of patients with DLGGs from 2 Norwegian university hospitals with different surgical treatment strategies. They demonstrated that treatment at a center that favored early resection was associated with better overall survival (median survival not reached) than treat- Object. Preserving function while optimizing the extent of resection is the main goal in surgery for diffuse lowgrade glioma (DLGG). This is particularly relevant for DLGG involving the sagittal stratum (SS), where damage can have severe consequences. Indeed, this structure is a major crossroad in which several important fascicles run. Thus, its complex functional anatomy is still poorly understood. Subcortical electrical stimulation during awake surgery provides a unique opportunity to investigate white matter pathways. This study reports the findings on anatomofunctional correlations evoked by stimulation during resection for gliomas involving the left SS. Surgical outcomes are also detailed.Methods. The authors performed a review of patients who underwent awake surgery for histopathologically confirmed WHO Grade II glioma involving the left SS in the neurosurgery department between August 2008 and August 2012. Information regarding clinicoradiological features, surgical procedures, and outcomes was collected and analyzed. Intraoperative electrostimulation was used to map the eloquent structures within the SS.Results. Eight consecutive patients were included in this study. There were 6 men and 2 women, whose mean age was 41.7 years (range 32-61 years). Diagnosis was made because of seizures in 7 cases and slight language disorders in 1 case. After cortical mapping, subcortical stimulation detected functional fibers running in the SS in all patients: semantic paraphasia was generated by stimulating the inferior frontooccipital fascicle in 8 cases; alexia was elicited by stimulating the inferior longitudinal fascicle in 3 cases; visual disorders were induced by stimulating the optic radiations in 5 cases. Moreover, in front of the SS, phonemic paraphasia was evoked by stimulating the temporal part of the arcuate fascicle in 5 patients. The resection was stopped according to these functional limits in the 8 patients. After a transient postsurgical worsening, all patients recovered to normal results on examination, except for the persistence of a right superior quadrantanopia in 5 cases, with no consequences for quality of life. The 8 patients returned to a normal social and professional life. Total or subtotal resection was achieved in all cases but one.Conclusions. The authors suggest that the use of intrasurgical electrical mapping of the white matter pathway...

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confidence: 99%

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Chan-Seng¹,

Moritz‐Gasser

Duffau

2014

JNS

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“…DES plays an important role in studies of such higher cognitive functions as hemispheric ignorance, perceptual awareness, music, calculation, memory and category-specific naming (12,(34)(35)(36)(37)(38)(39). In the present study, it was found that the Broca area of a Chinese population undergoing DES was mainly concentrated within a 1-cm range.…”

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confidence: 55%

Glioma localization and excision using direct electrical stimulation for language mapping during awake surgery

Bai

Wang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to investigate the method and significance of the application of direct electrical stimulation (DES) to the brain mapping of language functions during glioma surgery. A retrospective analysis of clinical data was performed for 91 cases of brain functional area glioma surgery under DES from January 2003 until January 2012. Following cortical electrical stimulation, 88 patients exhibited seizures involving facial or hand movements and 91 cases experienced language disorders such as counting interruption, naming errors or anomia. The most commonly observed areas of counting interruption were distributed on the posterior part of the left anterior central gyrus (47.7%), the operculum of the left inferior frontal gyrus (24.4%) and the triangular part of the left inferior frontal gyrus (12.8%). Postoperative magnetic resonance imaging demonstrated that overall excision was achieved in 53 cases and sub-overall excision was performed in 31 cases. A total of 42 cases (46.2%) exhibited no postoperative neurological dysfunction, 39 cases (42.9%) exhibited brief language dysfunction, 27 cases (29.7%) experienced brief limb movement disorder, and one case appeared to have permanent neurological dysfunction. DES was indicated to be a reliable and noninvasive method for the intraoperative positioning of language areas, and was able to resect gliomas in the language area with maximal safety.

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“…As a consequence, as recommended by the European guidelines, early surgery is currently the first treatment option to consider in DLGG [24]. This is the reason why some authors have achieved "supratotal" resection (i.e., extended resection with a margin beyond MR imaging-defined abnormalities) [25], especially in asymptomatic patients with incidental discovery of DLGG [8,18]. Thanks to the use of intraoperative functional mapping at both the cortical and subcortical level, favorable oncological and functional outcomes have been obtained [6].…”

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“…Indeed, it could be ethically acceptable to propose to a patient to voluntarily generate a permanent neurological deficit if it were possible to cure him or her. Nonetheless, even in cases of supratotal resection for DLGG located outside eloquent areas, whereas no malignant transformation has been observed yet, tumor relapse has already occurred [25]. Therefore, why elicit disabling sequelae by maximizing the resection for DLGG involving functional structures, knowing that the glioma will inescapably recur?…”

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confidence: 99%

Awake surgery for WHO Grade II gliomas within “noneloquent” areas in the left dominant hemisphere: toward a “supratotal” resection

Cited by 318 publications

References 38 publications

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Glioma localization and excision using direct electrical stimulation for language mapping during awake surgery

Preserving quality of life is not incompatible with increasing overall survival in diffuse low-grade glioma patients

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