Surgery of Insular Nonenhancing Gliomas

Škrap, Miran; Mondani, Massimo; Tomasino, Barbara; Weis, Luca; Budai, Riccardo; Pauletto, Giada; Eleopra, Roberto; Fadiga, Luciano; Ius, Tamara

doi:10.1227/neu.0b013e31823f5be5

Cited by 101 publications

(78 citation statements)

References 57 publications

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“…As previously described, the preoperative ∆T2T1 MRI index provides an imaging estimate of tumor growing pattern prevalence and the EOR achievable [12,15]. Kinetic analysis in low grade gliomas highlighted that tumor growth results from two main mechanisms: proliferation and diffusion [28,29].…”

Section: The Tumor Growth Pattern Influences the Postoperative Seizurmentioning

confidence: 97%

“…The prevalence of proliferation growth leads to a bulky tumor with a regular shape, determining similar tumor volume in both post-contrast T1-weighted MRI and T2-weighted preoperative MRI sequences; whereas the prevalence of the diffusive growth generates the tumor infiltration along the white matter, resulting in a complex shape with digitations more visible on T2-weighted images and less amenable of an extensive tumor resection [28,29].…”

Section: The Tumor Growth Pattern Influences the Postoperative Seizurmentioning

confidence: 99%

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Predictors of Postoperative Seizure Outcome in Low Grade Glioma: From Volumetric Analysis to Molecular Stratification

Ius

Pauletto

Tomasino

et al. 2020

Cancers

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The importance of the extent of resection (EOR) has been widely demonstrated as the main predictor for survival, nevertheless its effect on tumor related epilepsy is less investigated. A total of 155 patients were enrolled after a first-line surgery for supratentorial Diffuse Low Grade Gliomas (DLGGs). Postoperative seizure outcome was analyzed stratifying the results by tumor volumetric data and molecular markers according to 2016 WHO classification. Receiver operating characteristic (ROC) curves were computed to asses EOR, residual tumor volume, and ∆T2T1 MRI index (expressing the tumor growing pattern) corresponding to optimal seizure outcome. A total of 70.97% of patients were seizure-free 18 months after surgery. Better seizure outcome was observed in IDH1/2 mutated and 1p/19q codeleted subgroup. At multivariate analysis, age (p = 0.014), EOR (p = 0.030), ∆T2T1 MRI index (p = 0.016) resulted as independent predictors of postoperative seizure control. Optimal parameters to improve postoperative seizure outcome were EOR ≥ 85%, ∆T2T1 MRI index ≤ 18 cm 3 , residual tumor volume ≤ 15 cm 3 . This study confirms the role of EOR and tumor growing pattern on postoperative seizure outcome independently from the molecular class. Higher ∆T2T1 MRI index, representing the infiltrative component of the tumor, is associated with worse seizure outcome and strengthens the evidence of common pathogenic mechanisms underlying tumor growth and postoperative seizure outcome.to manifest with focal and focal-to-bilateral tonic-clonic seizures, and more than 50% of cases show pharmaco-resistance, which contributes negatively on quality of life [3][4][5]. Recent studies have pointed out that epileptogenesis and tumor growth in DLGG may share common pathogenic mechanisms that can influence each other, thus representing two aspects of the same disease [6]. In this context, several genetic alterations have been identified as risk factors of glioma-related epilepsy. Mutations of the gene encoding the isocitrate-dehydrogenase1 (IDH1) and 2 (IDH2) can be found in about 70%-80% of DLGG [7]. These mutations have been associated with metabolic changes that are potentially epileptogenic, in accordance with the capability of IDH-mutated glioma cells to penetrate and surround the neurons in the gray matter [8,9].Seizure outcome represents an important challenge in the daily management of DLGG patients. In particular, decision-making still varies across surgical centers given the lack of well-established and universally recognized predictors of seizure outcomes.In the last decades, numerous studies, based on the objective evaluation of the extent of resection (EOR) has been published, demonstrating that an extensive surgery leads to increased overall patient survival and decreased malignant progression [10][11][12][13][14].Although EOR has also been shown to be one of the main strongest significant predictor markers for seizure outcome [7,[15][16][17][18], its predictive role has not been completely clarified in complex predictor models for epilep...

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Section: The Tumor Growth Pattern Influences the Postoperative Seizurmentioning

confidence: 97%

Section: The Tumor Growth Pattern Influences the Postoperative Seizurmentioning

confidence: 99%

Predictors of Postoperative Seizure Outcome in Low Grade Glioma: From Volumetric Analysis to Molecular Stratification

Ius

Pauletto

Tomasino

et al. 2020

Cancers

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“…Knowledge of such alterations may provide useful information during neurosurgery, particularly in the case of infiltrating lesions, where the extent of excision and the prognosis are positively correlated (Skrap et al, 2004; Clark et al, 2003). In fact, while highly aggressive lesions significantly alter morphology and impair functionality of infiltrated WM, less aggressive tumors may simply displace the surrounding brain structures.…”

Section: Introductionmentioning

confidence: 99%

Alterations in fiber pathways reveal brain tumor typology: a diffusion tractography study

Campanella

Ius

Škrap

et al. 2014

PeerJ

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Conventional structural Magnetic Resonance (MR) techniques can accurately identify brain tumors but do not provide exhaustive information about the integrity of the surrounding/embedded white matter (WM). In this study, we used Diffusion-Weighted (DW) MRI tractography to explore tumor-induced alterations of WM architecture without any a priori knowledge about the fiber paths under consideration. We used deterministic multi-fiber tractography to analyze 16 cases of histologically classified brain tumors (meningioma, low-grade glioma, high-grade glioma) to evaluate the integrity of WM bundles in the tumoral region, in relation to the contralateral unaffected hemisphere. Our new tractographic approach yielded measures of WM involvement which were strongly correlated with the histopathological features of the tumor (r = 0.83, p = 0.0001). In particular, the number of affected fiber tracts were significantly (p = 0.0006) different among tumor types. Our method proposes a new application of diffusion tractography for the detection of tumor aggressiveness in those cases in which the lesion does not involve any major/known WM paths and when a priori information about the local fiber anatomy is lacking.

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“…Given the importance of extent of resection for progression-free and overall survival, maximal and safe resection remains critical [19][20][21][22][23][24][25][26]. Sanai et al introduced an anatomic classification of insular gliomas that correlates with extent of resection [25].…”

Section: Methodsmentioning

confidence: 99%

The transsylvian approach for resection of insular gliomas: technical nuances of splitting the Sylvian fissure

et al. 2016

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Insular gliomas represent a unique surgical challenge due to the complex anatomy and nearby vascular elements associated within the Sylvian fissure. For certain tumors, the transsylvian approach provides an effective technique for achieving maximal safe resection. The goal of this manuscript and video are to present and discuss the surgical nuances and appropriate application of splitting the Sylvian fissure. Our hope is that this video highlights the safety and efficacy of the transsylvian approach for appropriately selected insular gliomas.

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Surgery of Insular Nonenhancing Gliomas

Abstract: With intraoperative cortico-subcortical mapping and neurophysiological monitoring, a major resection is possible with an acceptable risk and a significant result in the follow-up.

Cited by 101 publications

References 57 publications

Predictors of Postoperative Seizure Outcome in Low Grade Glioma: From Volumetric Analysis to Molecular Stratification

Predictors of Postoperative Seizure Outcome in Low Grade Glioma: From Volumetric Analysis to Molecular Stratification

Alterations in fiber pathways reveal brain tumor typology: a diffusion tractography study

The transsylvian approach for resection of insular gliomas: technical nuances of splitting the Sylvian fissure

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