Iterative Surgical Resections of Diffuse Glioma With Awake Mapping: How to Deal With Cortical Plasticity and Connectomal Constraints?

Neurosurgery
Thiébaud PicartH Duffau

Abstract

In diffuse glioma, a multistage approach with iterative tailored surgical resections can be considered. To compare results of iterative intrasurgical brain mappings to investigate the potential and limitation of neuroplasticity at the individual stage, and to highlight to what extent it can influence the therapeutic strategy. Glioma patients who underwent 2 consecutive awake surgeries with cortical and subcortical stimulation were classified into group 1 (n = 23) if cortical mappings exhibited high level of plasticity (displacement of ≥2 sites) or into group 2 (n = 19) with low level of plasticity. Clinical characteristics did not differ significantly between both groups. The borders of the tumors were mostly sharp in group 1 (82.6%) and rather indistinct in group 2 (84.2%), (P = .00001). Tumor remnants were more often cortical (± subcortical) in group 1 (39.1%) and more often purely subcortical in group 2 (68.4%; P = .009). In group 1, the time needed to recover independence was significantly shorter at reoperation (37.6 h vs 78.3 h after the first surgery, P = .00003) while this difference was not significant in group 2. The iterative extents of resection (EOR) remain comparable in group 1 (94% vs 92%, P = .40) but were signi...Continue Reading

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Citations

Jul 17, 2020·International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group·Josue M Avecillas-ChasinGene H Barnett
Jun 25, 2019·Frontiers in Oncology·Sebastian IlleSandro M Krieg
Feb 16, 2021·Neurosurgery·Christina Weyer-JamoraJennie W Taylor
Jan 3, 2021·Journal of Pediatric Rehabilitation Medicine·Yahya GhazwaniIbrahim Qaddoumi
Jul 8, 2021·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Luca PasquiniAlessandro Bozzao

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