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Updated: Apr 21, 2026
Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping
Published on: August 12, 2019
Resection of supratentorial gliomas: the need to merge microsurgical technical cornerstones with modern functional
Giannantonio Spena1, Pier Paolo Panciani, Marco Maria Fontanella
1Neurosurgery Department, Spedali Civili and University of Brescia, Brescia, Italy, giannantonios@hotmail.com.
Abstract:
Although surgery is not curative for the majority of intracranial gliomas, radical resection has been demonstrated to influence survival and delay tumor progression. Because gliomas are very frequently located in eloquent or more generally critical areas, surgeons must always balance the maximizing resection with the need to preserve neurological function. In this overview, we tried to summarize the recent literature and our personal experience about (1) the benefits and limits of using preoperative anatomical and functional neuroimaging (anatomical MRI, DTI fiber tracking, and functional MRI), (2) the issues to consider in planning the surgical strategy, (3) the need to thoroughly understand microsurgical techniques that enable a maximal resection (subpial dissection, vascular manipulation, etc.), (4) the importance of individualizing surgical strategy especially in patients with gliomas in eloquent areas (the role of neuropsychological evaluation in redefining eloquent and non-eloquent areas), and (5) how to use intraoperative mapping techniques and understand why and when to use them. Through this paper, the reader should become more familiar with a comprehensive panel of techniques and methodologies but more importantly become aware that these recent technical advances facilitate a conceptual change from classical surgical paradigms toward a more patient-specific approach.
Insights
Maximizing surgical resection of intracranial gliomas can improve survival. Advanced neuroimaging and patient-specific strategies are crucial for balancing tumor removal with preserving neurological function.
Area of Science:
- Neurosurgery
- Oncology
- Neuroimaging
Background:
- Intracranial gliomas often necessitate surgery, though not curative.
- Radical resection impacts survival and tumor progression.
- Glioma location in critical brain areas complicates maximal resection while preserving function.
Purpose of the Study:
- To review current literature and personal experience on optimizing surgical resection for intracranial gliomas.
- To highlight the integration of advanced neuroimaging and surgical techniques.
- To emphasize a patient-specific approach in glioma surgery.
Main Methods:
- Review of preoperative anatomical and functional neuroimaging (MRI, DTI, fMRI).
- Analysis of surgical planning considerations.
- Evaluation of microsurgical techniques for maximal resection.
- Discussion of individualized strategies for eloquent area gliomas.
- Assessment of intraoperative mapping techniques.
Main Results:
- Preoperative neuroimaging aids in surgical planning and strategy.
- Microsurgical techniques enable more extensive tumor resection.
- Neuropsychological evaluation is key for defining eloquent areas.
- Intraoperative mapping refines surgical decision-making.
- Technical advances support a shift towards patient-specific surgical paradigms.
Conclusions:
- A comprehensive understanding of advanced techniques is essential for glioma surgery.
- Modern approaches facilitate a conceptual shift towards personalized surgical strategies.
- Balancing maximal resection with functional preservation remains paramount.
