Multimodal integrated approaches in low grade glioma surgery

Abstract

Surgical management of Diffuse Low-Grade Gliomas (DLGGs) has radically changed in the last 20 years. Awake surgery (AS) in combination with Direct Electrical Stimulation (DES) and real-time neuropsychological testing (RTNT) permits continuous intraoperative feedback, thus allowing to increase the extent of resection (EOR). The aim of this study was to evaluate the impact of the technological advancements and integration of multidisciplinary techniques on EOR. Two hundred and eighty-eight patients affected by DLGG were enrolled. Cases were stratified according to the surgical protocol that changed over time: 1. DES; 2. DES plus functional MRI/DTI images fused on a NeuroNavigation system; 3. Protocol 2 plus RTNT. Patients belonging to Protocol 1 had a median EOR of 83% (28–100), while those belonging to Protocol 2 and 3 had a median EOR of 88% (34–100) and 98% (50–100) respectively (p = 0.0001). New transient deficits with Protocol 1, 2 and 3 were noted in 38.96%, 34.31% and 31,08% of cases, and permanent deficits in 6.49%, 3.65% and 2.7% respectively. The average follow-up period was 6.8 years. OS was influenced by molecular class (p = 0.028), EOR (p = 0.018) and preoperative tumor growing pattern (p = 0.004). Multimodal surgical approach can provide a safer and wider removal of DLGG with potential subsequent benefits on OS. Further studies are necessary to corroborate our findings.

The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude

“…In spite of the latest Cochrane review (2017) on biopsy versus resection for low-grade gliomas, stating that there are no randomized controlled trials to determine the best surgical choice [56], numerous systematic reviews and meta-analysis confirm a positive correlation between EOR and overall survival (OS) in DLGG [22,[57][58][59], along with some of the most recently published single-institution experiences [60][61][62][63][64]. The longer OS achieved is related to a change in the natural history of the disease, surgery allowing us to significantly reduce the risk of malignant transformation, thanks to a decrease in the number of tumor cells.…”

PATZ1 Induces Apoptosis through PUMA in Glioblastoma

“…Glioma cells in the logarithmic phase were seeded in 24-well plates with cell slides at a density of 10 [ 6 ] cells/well, and the cells were fixed with 4% PFA after 24 h and stained using a TUNEL apoptosis detection kit (Beyotime, Beijing, China) according to the instructions, mounted with DAPI staining solution and stained the nucleus, and finally observed under an inverted microscope (Olympus, Tokyo, Japan).…”

“…Glial cells are the most abundant cell type in the central nervous system, and these glial cells surround and sequester neurons and provide nutrients and oxygen to neurons [ 3 ]. Epidemiology shows that malignant brain tumors occur frequently in men, and meningiomas and other nonmalignant tumors are more common in women [ 4 – 6 ].…”

Protocadherin Gamma C3 (PCDHGC3) Is Strongly Expressed in Glioblastoma and Its High Expression Is Associated with Longer Progression-Free Survival of Patients

“…An important molecular biological marker is isocitrate dehydrogenase (IDH), which is present either in its wild type (IDHwt) or in a mutated form (IDHmut). Mutations occur predominantly in the less malignant astrocytomas and oligodendrogliomas, WHO grade 2 and 3 (gliomas grade 2/3), and these patients often have a better prognosis than patients with IDHwt [ 3 , 4 , 5 ]. In the recent WHO classification of 2021, the differences between IDHwt and IDHmut gliomas were addressed by weighing the impact of an IDH mutation higher than the morphological criteria that built the backbone of brain tumor classifications for almost a century.…”