Surgical management of World Health Organization Grade II gliomas in eloquent areas: the necessity of preserving a margin around functional structures

Neurosurgical Focus
Santiago Gil-Robles, Hugues Duffau

Abstract

Recent surgical studies have demonstrated that the extent of resection is significantly correlated with median survival in WHO Grade II gliomas. Consequently, thanks to advances in intraoperative functional mapping, the authors questioned whether it is actually necessary to leave a "security" margin around eloquent structures. The authors first reviewed the classic literature, especially that based on epilepsy surgery and functional neuroimaging techniques, which led them to propose the rule of a security margin. Second, they detailed new developments in the field of intrasurgical electrical mapping, especially with regard to subcortical stimulation of the projection and long-distance association pathways. On the basis of these advances, the removal of gliomas according to functional boundaries has recently been suggested, with no margin around eloquent structures. Comparative results showed that the rate of permanent deficit was similar with or without a security margin, that is, < 2%. However, a higher rate of transient neurological worsening in the immediate postsurgical period was associated with the absence of a margin, with recovery following adapted rehabilitation. On the other hand, the extent of resection was in essenc...Continue Reading

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Citations

May 4, 2011·Brain Structure & Function·Igor Lima MaldonadoHugues Duffau
Aug 1, 2012·Radiology Research and Practice·Ioannis Z KapsalakisKostas N Fountas
Oct 5, 2010·Neurologia Medico-chirurgica·Nobuhiro Mikuni, Susumu Miyamoto
Aug 3, 2010·Journal of Neurosurgery·Matthieu VassalHugues Duffau
Feb 15, 2011·Journal of Neurosurgery·Asgeir S JakolaOle Solheim
Feb 5, 2013·Neurosurgical Focus·Roberto Rey-Dios, Aaron A Cohen-Gadol
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Aug 16, 2011·Acta neurochirurgica·Catarina ViegasHugues Duffau
Nov 11, 2011·Acta neurochirurgica·Young-Hoon KimChun Kee Chung
Jun 7, 2012·Acta neurochirurgica·Marie-Thérèse ForsterAndrea Szelényi
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Sep 21, 2013·Cortex; a Journal Devoted to the Study of the Nervous System and Behavior·Hugues Duffau
Nov 26, 2014·Journal of Neurosurgery·Edward F ChangMitchel S Berger

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