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

Duffau, Hugues

doi:10.1007/s00701-014-2303-6

Cited by 20 publications

(5 citation statements)

References 26 publications

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“…Although surgery plays a central role in the management of LGG patients today, its value has been debated for many years [ 21 , 61 , 62 ].…”

Section: Role Of Surgerymentioning

confidence: 99%

“…The main aim in LGG surgery is to preserve functional integrity with maximal tumor resection [ 61 , 70 , 76 , 79 , 80 ]. With regard to radical resection in LGG, the critical areas that are of utmost importance in preserving quality-of-life functions and limiting functional damage postoperatively include the eloquent cortical areas and subcortical functional pathways.…”

Section: Role Of Surgerymentioning

confidence: 99%

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Clinical Management of Diffuse Low-Grade Gliomas

Lombardi

Barresi

Castellano

et al. 2020

Cancers

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Diffuse low-grade gliomas (LGG) represent a heterogeneous group of primary brain tumors arising from supporting glial cells and usually affecting young adults. Advances in the knowledge of molecular profile of these tumors, including mutations in the isocitrate dehydrogenase genes, or 1p/19q codeletion, and in neuroradiological techniques have contributed to the diagnosis, prognostic stratification, and follow-up of these tumors. Optimal post-operative management of LGG is still controversial, though radiation therapy and chemotherapy remain the optimal treatments after surgical resection in selected patients. In this review, we report the most important and recent research on clinical and molecular features, new neuroradiological techniques, the different therapeutic modalities, and new opportunities for personalized targeted therapy and supportive care.

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“…Although surgery plays a central role in the management of LGG patients today, its value has been debated for many years [ 21 , 61 , 62 ].…”

Section: Role Of Surgerymentioning

confidence: 99%

Section: Role Of Surgerymentioning

confidence: 99%

Clinical Management of Diffuse Low-Grade Gliomas

Lombardi

Barresi

Castellano

et al. 2020

Cancers

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show abstract

“…I will describe some underlying constituents of the apparent disagreement between Brennum's team and of Duffau, who criticised their original suggestion in an editorial [2], taking into acount a recent response by Brennum's team [3]. I will complicate the issue on a theoretical level, keeping apart a number of distinct ethics considerations.…”

Section: Dear Editormentioning

confidence: 98%

The ethics of “primo non nocere”, professional responsibility and shared decision making in high-stakes neurosurgery

Munthe

2015

Acta Neurochir

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“…However, most patients seek not only for a longer life but also for a life that is worth living (according to their own de nition). This problem has been conceptualized as oncofunctional balance [13,16,42,43], and subspecialized neurosurgeons must face the challenge of optimizing this oncofunctional balance. Whereas noninvasive preoperative functional imaging tools (functional and structural MRI, magnetoencephalography, transcranial magnetic stimulation) are helpful in the rst approach of individualized functional mapping (especially in regard to determining language lateralization [46]), the best methodology for functional preservation is to awake the patient and perform continuous intraoperative mapping of cognitive tasks through the use of direct electrical stimulation (DES) [19].…”

Section: Introductionmentioning

confidence: 99%

Neuropsychological Outcomes After Awake Resections of Right Frontal IDH-Mutated Glioma: Insights From a Consecutive Series of 20 Cases.

Barberis

Poisson

Facque

et al. 2021

Preprint

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Background Awake surgery for low-grade gliomas is currently considered the best procedure to improve the extent of resection and guarantee a "worth living life" for patients, meaning avoiding not only motor but also cognitive deficits. However, tumors located in the right hemisphere, especially in the right frontal lobe, are still rarely operated on in awake condition; one of the reasons possibly being that there is little information in the literature describing the rates and nature of long-lasting neuropsychological deficits following resection of right frontal glioma. Objective To investigate long-term cognitive deficits after awake surgery in right frontal IDH-mutated glioma. Methods We retrospectively analyzed a consecutive series of awake surgical resections between 2012 and 2020 for right frontal IDH-mutated glioma. We studied the patients' subjective complaints and objective neuropsychological evaluations, both before and after surgery. Our results were then put in perspective with the literature. Results Twenty surgical cases (including 5 cases of redo surgery) in eighteen patients (medium age: 42.5 [range 26–58]) were included in the study. The median preoperative volume was 37 cc; WHO grading was II, III and IV in 70%, 20%, and 10% of cases, respectively. Preoperatively, few patients had related subjective cognitive or behavioral impairment, while evaluations revealed mild deficits in 45% of cases, most often concerning executive functions, attention, working memory and speed processing. Immediate postoperative evaluations showed severe dysexecutive syndrome in 75% of cases but also attentional deficits (65%), spatial neglect (60%) and behavioral disturbances (apathy, aprosodia/amimia, emotional sensitivity, anosognosia). Four months after surgery, although psychometric z-scores were unchanged at the group level, individual evaluations showed a slight decrease in performance in 9/20 cases (dysexecutive syndrome, speed processing, attention, semantic cognition, social cognition). Conclusion Our results are generally consistent with those of the literature, confirming that the right frontal lobe is a highly eloquent area and highlighting the importance of operating these patients in awake conditions.

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

Cited by 20 publications

References 26 publications

Clinical Management of Diffuse Low-Grade Gliomas

Clinical Management of Diffuse Low-Grade Gliomas

The ethics of “primo non nocere”, professional responsibility and shared decision making in high-stakes neurosurgery

Neuropsychological Outcomes After Awake Resections of Right Frontal IDH-Mutated Glioma: Insights From a Consecutive Series of 20 Cases.

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