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A Protocol for Explant Cultures of IDH1-mutant Diffuse Low-grade Gliomas
Published on: May 9, 2025
Functional Mapping-Guided Resection of Eloquent Diffuse Low-Grade Gliomas: A Single-Institution Experience from a
Seif Tarek El-Swaify1, Ahmed M Ashour1, Mohamed Mostafa Aziz1
1Ain Shams University, Department of Neurosurgery, Cairo, Egypt.
Abstract:
AIM: To report our experience in implementing functional mapping-guided resection for eloquent diffuse low-grade gliomas (DLGGs) in a low- and middle-income country (LMIC) setting. There are logistical barriers to achieving onco-functional balance through glioma surgery in LMICs. MATERIAL and METHODS: The study is a retrospective chart review of adult patients who underwent surgical resection of their DLGGs that were located within supratentorial eloquent brain areas (within 15 mm). Functional mapping-guided surgery was performed using electrophysiological brain mapping techniques, namely intraoperative neuromonitoring (IONM) with or without awake craniotomy (AC). The primary outcome was the rate of postoperative neurological deficits. The secondary outcomes were the extent of resection, the rate of surgical complications, the Engel Outcome Scale score, and the progression-free survival (PFS) rate. RESULTS: Twenty-eight patients were included (43% males), with a mean age of 37.5 years. Their median preoperative Karnofsky Performance Scale score was 90. The predominant histopathology was astrocytoma (n = 20, 71%), and the primary site was perirolandic in 19 patients (68%). Seizures were the most common presenting symptom (71%). Resection was performed using either IONM alone (39%) or combined with AC (61%). Gross total resection was achieved in 20 patients. Six patients (21%) developed postoperative complications. Patients were followed up for a mean of 39.9 months. At discharge, 12 patients (43%) had experienced new or worsened neurological deficits, but nine of them later showed significant improvement. Sixteen patients achieved Engel class 1 seizure control, and the median PFS was 34 months. Two patients died during the study period. CONCLUSION: This study demonstrates that our institution's protocol for integrating functional mapping into the surgical management of DLGGs achieves a solid onco-functional balance.
