Higher-Order Surgical Questions for Diffuse Low-Grade Gliomas: Supramaximal Resection, Neuroplasticity, and Screening

Diffuse low-grade glioma (DLGG) is a brain neoplasm that migrates within the connectome and that becomes malignant if left untreated. Early and maximal safe surgical resection by means of awake mapping enables a significant improvement of survival and quality of life. Supramaximal functional-based resection seems to prevent DLGG malignant transformation. Neuroplasticity is helpful to remove DLGG in eloquent areas. When radical excision cannot be achieved due to invasion of critical neural networks, cerebral remapping over time may lead to a reoperation with an optimized resection. To discover and treat DLGG earlier, a screening in the general population should be considered.