Resection of supratentorial gliomas: the need to merge microsurgical technical cornerstones with modern functional mapping concepts. An overview

Abstract

Although surgery is not curative for the majority of intracranial gliomas, radical resection has been demonstrated to influence survival and delay tumor progression. Because gliomas are very frequently located in eloquent or more generally critical areas, surgeons must always balance the maximizing resection with the need to preserve neurological function. In this overview, we tried to summarize the recent literature and our personal experience about (1) the benefits and limits of using preoperative anatomical and functional neuroimaging (anatomical MRI, DTI fiber tracking, and functional MRI), (2) the issues to consider in planning the surgical strategy, (3) the need to thoroughly understand microsurgical techniques that enable a maximal resection (subpial dissection, vascular manipulation, etc.), (4) the importance of individualizing surgical strategy especially in patients with gliomas in eloquent areas (the role of neuropsychological evaluation in redefining eloquent and non-eloquent areas), and (5) how to use intraoperative mapping techniques and understand why and when to use them. Through this paper, the reader should become more familiar with a comprehensive panel of techniques and methodologies but more importantly become aware that these recent technical advances facilitate a conceptual change from classical surgical paradigms toward a more patient-specific approach.

White matter tractography for neurosurgical planning: A topography-based review of the current state of the art

“…WMT is the only preoperative noninvasive tool for studying white matter tracts, which is advantageous for risk stratification, patient counseling, and surgical planning (Berman, 2009, Farshidfar et al, 2014, Romano et al, 2009, Rosenstock et al, 2017). Understanding the spatial configuration of the white matter helps finding the safest corridor particularly in deeply situated lesions (Farshidfar et al, 2014, Spena et al, 2015, Tunc et al, 2015). For instance, Barbosa et al reported a statistically significant improvement of the post-operative Karnofsky Performance Scale by the implementation of WMT during the resection of insular gliomas (Barbosa et al, 2016).…”

International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

“…Preoperative planning includes creating a precise threedimensional (3D) concept of the surgical target area and the trajectory leading to it. This is achieved by the acquisition and study of detailed multimodality imaging series, including CT, MRI, f-MRI, diffusion tensor imaging-tractography, and detailed arterial and venous vascular imaging [2,18,21,22,48,63,69]. According to preoperative imaging, the direction of aneurysm and the compensation of collateral circulation are closely related to the choice of surgical approach.…”

Cognitive Decline following Radiotherapy of Head and Neck Cancer: Systematic Review and Meta-Analysis of MRI Correlates

“…In recent years, advances in brain imaging such as fibre tracking by diffusion imaging and functional mapping have shown their potential in the radiosurgical and surgical management of brain tumours [ 25 , 26 , 27 ]. These advancements could be beneficial should they be employed in the management of head and neck cancer treatment by monitoring brain microstructural changes.…”