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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

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Oncological and functional neurosurgery: Perspectives for the decade regarding diffuse gliomas.

¹Department of Neurosurgery, Montpellier University Medical Center, Gui-de-Chauliac Hospital, 80, avenue Augustin-Fliche, 34295 Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", National Institute for Health and Medical Research (Inserm), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, 34091 Montpellier, France.

Revue Neurologique

|March 12, 2023

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Diffuse glioma (DG) research now prioritizes functional outcomes alongside survival, shifting towards connectome-guided surgery and personalized therapies to preserve quality of life.

Area of Science:

Neuro-oncology
Neurosurgery
Neuroscience

Background:

Diffuse glioma (DG) research historically prioritized oncological outcomes over functional aspects.
Increased survival in DG, particularly low-grade glioma, necessitates a greater focus on quality of life, including neurocognitive and behavioral preservation.
Maximal tumor resection improves survival, prompting a reevaluation of surgical strategies.

Purpose of the Study:

To shift the paradigm in diffuse glioma management towards integrating functional outcomes with oncological goals.
To explore advanced surgical techniques like connectome-guided resection under awake mapping to minimize functional deficits.
To emphasize personalized, multistage therapeutic strategies that account for glioma progression and neuroplasticity.

Main Methods:

Keywords:

Awake mapping Diffuse gliomas Overall Survival Quality of life Surgery

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Transitioning from traditional tumor-mass resection to connectome-guided resection using awake mapping.
Considering inter-individual brain anatomo-functional variability in surgical planning.
Developing a deeper understanding of the dynamic interplay between glioma progression and neuroplasticity.

Main Results:

Connectome-guided resection aims to maximize tumor removal while minimizing functional risks.
Personalized, multistage therapeutic strategies are crucial for optimizing onco-functional benefits.
Predicting glioma behavior and neural network reconfiguration is key to adaptive treatment.

Conclusions:

A paradigm shift towards "preventive neuro-oncology" is needed, integrating functional outcomes and personalized strategies.
New endpoints, such as return to work, should be included in diffuse glioma trials.
Early detection and treatment of incidental gliomas may improve long-term patient outcomes.