Microsurgery of gliomas

The author describes his microsurgical operative technique used since 1980 for gliomatous tumours. Instead of extensive resection and lobectomy, a pergyral or intergyral persulcal approach with partial gyrectomy, interhemispheric, transsylvian and transventricular exposure of the tumour surface were used. The resection of the tumour begins from its centre. In the first phase 1980-1982 bipolar coagulation, micro-sucker and pincer were used, since 1983 tumour resections have been performed with the CO2 and Nd-Yag laser and CUSA. Tumours located in functionally important regions such as the speech area, thalamus, brain stem, etc. could be removed without additional morbidity and there was a rapid improvement in neurological deficits. The early prognosis of patients harbouring these tumours is improved thanks to minimized operative trauma. The quality of life during the recurrence free period is improved and surgery of recurrence is indicated more frequently than in the past. There is no evidence that these techniques influence the length of the total survival. The use of CT and MRI improved the early diagnosis of small tumours and intraparenchymal lesions. This requires exact intraoperative localization and identification of the lesion. The technical aspects of these procedures are described. Thanks to the improvement in operative technique some limitations of surgery such as location, nature of the tumour and the age of the patient have lost much of their importance.