Improving surgical outcome for gliomas with intraoperative mapping

Abstract

Radical glioma resection improves overall survival, both in low-grade and high-grade glial tumors. However, preservation of the quality of life is also crucial. Areas covered: Due to the diffuse feature of gliomas, which invade the central nervous system, and due to considerable variations of brain organization among patients, an individual cerebral mapping is mandatory to solve the classical dilemma between the oncological and functional issues. Because functional neuroimaging is not reliable enough, intraoperative electrical stimulation, especially in awake patients benefiting from a real-time cognitive monitoring, is the best way to increase the extent of resection while sparing eloquent neural networks. Expert commentary: Here, we propose a paradigmatic shift from image-guided resection to functional mapping-guided resection, based on the study of the dynamic distribution of delocalized cortico-subcortical circuits at the individual level, i.e., the investigation of brain connectomics and neuroplastic potential. This surgical philosophy results in an improvement of both oncological outcomes and quality of life. This highlights the need to reinforce the link between glioma surgery and cognitive neurosciences.

Altered corticospinal microstructure and motor cortex excitability in gliomas: an advanced tractography and transcranial magnetic stimulation study

“…From a neurosurgical perspective, it is mandatory to spare functional white matter tracts, which often constitute the functional boundary of resection identified with intraoperative mapping. 30 There is extensive literature to suggest that gliomas can change the diffusion profile of white matter tracts, as assessed on preoperative tractography. Several studies have reported that white matter microstructure can be affected by tumors.…”

The Dilemma of Cure and Damage in Oligodendroglioma: Ways to Tip the Balance Away from the Damage

“…A MasSpec Pen was described adding to even better surgical removal of the tumor [ 34 ]. Awake surgery of the brain is yet another way to remove the tumor while sparing the healthy tissue [ 1 , 35 ]. However, awake surgery is not applicable to all patients due to anxiety and memories of the procedure [ 36 ].…”

Can Non-invasive Brain Stimulation Be Considered to Facilitate Reoperation for Low-Grade Glioma Relapse by Eliciting Neuroplasticity?

“…Nonetheless, despite this major improvement of functional and oncological outcomes following LGG surgery in the two past decades (11), because of its intrinsic diffuse nature, LGG cannot be cured, as evidenced by relapse that may arise even many years after supratotal resection (4). As a consequence, reoperation(s) has been advocated in the event of LGG recurrence, with the aim of reducing again the tumor volume and then decreasing the risk of malignant transformation and prolonging overall survival (12, 13).…”