Network Plasticity and Intraoperative Mapping for Personalized Multimodal Management of Diffuse Low-Grade Gliomas

Abstract

Gliomas are the most frequent primary brain tumors and include a variety of different histological tumor types and malignancy grades. Recent achievements in terms of molecular and imaging fields have created an unprecedented opportunity to perform a comprehensive interdisciplinary assessment of the glioma pathophysiology, with direct implications in terms of the medical and surgical treatment strategies available for patients. The current paradigm shift considers glioma management in a comprehensive perspective that takes into account the intricate connectivity of the cerebral networks. This allowed significant improvement in the outcome of patients with lesions previously considered inoperable. The current review summarizes the current theoretical framework integrating the adult human brain plasticity and functional reorganization within a dynamic individualized treatment strategy for patients affected by diffuse low-grade gliomas. The concept of neuro-oncology as a brain network surgery has major implications in terms of the clinical management and ensuing outcomes, as indexed by the increased survival and quality of life of patients managed using such an approach.

Similarities and differences in neuroplasticity mechanisms between brain gliomas and nonlesional epilepsy

“…A major revolution in epilepsy surgery was brought in the 20th century by Talairach and Bancaud, who moved from a static conception of the ictal‐onset zone to the definition of epileptic networks. A possible next step could be to integrate neuroplasticity, as well as the evolution of individual functional maps, in the management of drug‐resistant epilepsy, in a way that is comparable to what has been proposed in glioma surgery …”

“…A possible next step could be to integrate neuroplasticity, as well as the evolution of individual functional maps, in the management of drug-resistant epilepsy, in a way that is comparable to what has been proposed in glioma surgery. 90…”

Diffusion Tensor Imaging Shows Corpus Callosum Differences between High‐Grade Gliomas and Metastases

“…This is in line with the recent study done by Tantillo et al, 32 which observed that FA values were higher in left-hemispheric brain tumor patients that were codominant for language tasks than those that were left-dominant, and this was suspected to be due to contralateral brain reorganization in the codominant group. Although contralateral reorganization is usually associated with low-grade gliomas 42,43 because of their typically longer median survival time compared to HGGs, contralateral reorganization has been suggested to occur in HGG patients as well. 22,32 In addition, the median survival time for HGG patients is known to be longer than that for MET patients, [34][35][36] so our results provide further evidence that a higher degree of contralateral brain reorganization can occur if the brain is given more time to undergo reorganization.…”

Odotopia and Intraoperative Brain Mapping: Implications for Management of Patients with Diffuse Low-grade Gliomas

“…This framework contributed so much to refine the contemporary concepts of language organization as we above described. So in order to prevent permanent deficits that may decrease quality of life, a patient with a low-grade glioma, with a constant but slow growth until to change to anaplasia, may take advantage of serial incomplete surgical removals which, if on the one hand may be considered therapeutically disappointing, the other part may open the way to a "multistaged" surgical approach, supported by serial functional neuroimaging to show the changes occurring after surgery and depending on the plasticity [9][10][11]. By this way it is possible to remove in another future procedure a portion of infiltrated tissue, functionally active at that time and that, because of the plasticity, may become inactive with time.…”