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Published on: August 12, 2019
Surgery of low-grade gliomas: towards a 'functional neurooncology'
1Department of Neurosurgery, Hôpital Gui de Chauliac, France. h-duffau@chu-montpellier.fr
Purpose Of Review:
For a long time, surgery of diffuse low-grade glioma was debated because of the poor knowledge of the natural history, the lack of objective evaluation of the extent of resection, a too short follow-up and the functional risk. Recently, new technical and conceptual advances in surgery have dramatically changed the management.
Recent Findings:
Despite the lack of class I evidence, there is currently growing evidence that a more extensive surgical resection of low-grade glioma is associated with a more favorable life expectancy. The use of cortical and subcortical functional mapping allows us to tailor the resection according to individual functional boundaries, thus optimizing the extent of resection while minimizing the risk of permanent deficit less than 2%. The quality of life may also be improved, thanks to seizures control and functional rehabilitation.
Summary:
Early surgery is currently the first treatment in low-grade glioma. Re-operation can also be considered, possibly more extensive than the first one, thanks to a functional remapping and/or a tumor shrink induced by neoadjuvant treatment, especially chemotherapy. The next step is to better evaluate the quality of life and to continue to improve it in addition to the survival to evolve towards a 'functional neurooncology'.
Insights
Early surgery for diffuse low-grade glioma improves life expectancy and quality of life. Advances in surgical techniques and functional mapping enable more extensive resections with minimal permanent deficits.
Area of Science:
- Neurosurgery
- Oncology
- Neuroscience
Background:
- Diffuse low-grade gliomas present management challenges due to limited understanding of natural history and surgical risks.
- Historically, debates surrounded surgical intervention for these tumors, impacting treatment strategies.
Purpose of the Study:
- To review recent advances in surgical management of diffuse low-grade gliomas.
- To highlight the evolving role of surgery in improving patient outcomes.
Main Methods:
- Review of current literature on surgical techniques for low-grade gliomas.
- Emphasis on functional mapping and intraoperative neurophysiological monitoring.
- Analysis of outcomes related to extent of resection and quality of life.
Main Results:
- Extensive surgical resection of low-grade gliomas is increasingly associated with improved survival, despite limited class I evidence.
- Cortical and subcortical functional mapping allows for tailored resections, optimizing extent while minimizing permanent deficits (<2%).
- Improved quality of life is achievable through seizure control and functional rehabilitation post-surgery.
Conclusions:
- Early surgical intervention is now the primary treatment for diffuse low-grade gliomas.
- Re-operation, potentially more extensive, is a viable option, aided by functional remapping and neoadjuvant therapies.
- Future research should focus on enhancing quality of life alongside survival, advancing 'functional neurooncology'.
