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Surgical resection of incidental diffuse gliomas involving eloquent brain areas. Rationale, functional,
G L O Lima1, E Dezamis2, R Corns3
1Department of Neurosurgery, Onofre Lopes University Hospital, Rio Grande do Norte Federal University, Natal, RN, Brazil; Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
Objective:
Incidentally discovered diffuse low-grade gliomas progress in a fashion similar to their symptomatic counterparts. Their early detection allows more effective pre-emptive and individualized oncological treatment. We assessed the safety and efficacy of maximal safe resection according to functional boundaries for incidental diffuse low-grade gliomas in eloquent areas.
Material And Methods:
Two-centre retrospective series of adult patients with incidental diffuse low-grade gliomas located within/close to eloquent areas in the dominant hemisphere, treated with maximal surgical resection according to functional boundaries under intraoperative functional cortico-subcortical monitoring under awake conditions, and with a minimal follow-up of 24months.
Results:
The series included 19 patients (8 men, 11 women) with no preoperative neurological deficit but with a radiologically enlarged glioma. No intraoperative seizure, postoperative infection, haematoma or wound-healing problem was observed. In the immediate postsurgical period, a transient neurological worsening occurred in 10 patients. The resection (mean rate 96.4%; range, 82.4-100) was supratotal in 5 cases, total in 5 cases, subtotal in 7 cases, and partial in 2 cases. Six months after surgery, all patients recovered after functional rehabilitation, with no permanent neurological deficit, Karnofsky Performance Status was 100 (except for one patient who received early postoperative radiotherapy) and no seizures were observed. The survival without progression requiring oncological treatment was significantly longer in patients with a total/supratotal resection than in patients with a partial/subtotal resection.
Conclusions:
These results suggest the reproducibility, safety, and effectiveness of an early maximal functionally based resection within cortico-subcortical functional boundaries for incidental diffuse low-grade gliomas in adults in centres hyperspecialized in surgical neuro-oncology.
Insights
Early maximal safe resection of incidental diffuse low-grade gliomas in eloquent areas is safe and effective. Achieving total or supratotal resection significantly improves progression-free survival, leading to better patient outcomes.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Neuroradiology
Background:
- Incidental diffuse low-grade gliomas (IDLGGs) detected incidentally share similar progression patterns to symptomatic gliomas.
- Early detection of IDLGGs enables proactive and personalized oncological management.
- Eloquent area gliomas pose unique surgical challenges due to proximity to critical brain functions.
Purpose of the Study:
- To evaluate the safety and efficacy of maximal safe surgical resection for IDLGGs in eloquent areas.
- To assess the impact of resection extent on patient outcomes and progression-free survival.
- To determine the feasibility of functionally guided maximal resection in specialized neurosurgical centers.
Main Methods:
- Retrospective analysis of adult patients with IDLGGs in eloquent areas across two centers.
- Maximal safe resection guided by functional boundaries under intraoperative awake monitoring.
- Minimum follow-up of 24 months to assess long-term outcomes.
Main Results:
- Nineteen patients with IDLGGs in eloquent areas underwent surgery with no intraoperative complications.
- Transient neurological worsening occurred in 10 patients post-surgery, with full recovery in all by 6 months.
- Total or supratotal resection (mean 96.4% resection rate) was associated with significantly longer progression-free survival compared to partial/subtotal resection.
Conclusions:
- Maximal safe resection guided by functional boundaries is a reproducible, safe, and effective approach for IDLGGs in eloquent areas.
- Early, aggressive surgical management in hyperspecialized centers can lead to favorable long-term outcomes.
- Functionally based maximal resection is crucial for optimizing outcomes in patients with incidental gliomas.
