Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points

Abstract

Objectives:Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations.Materials and Methods:The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors.Results:Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia.Conclusion:In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.

Intraoperative detection ofIDH‐mutant glioma using fluorescence lifetime imaging

“…While the extent of surgical resection has been associated with improved survival for gliomas in general [7], the improved response of oligodendrogliomas to adjuvant therapy reduces the importance of gross total resection in these tumors. More aggressive resections, while beneficial to survival, are more likely to damage eloquent parts of the brain [8]. Therefore, aggressive surgery with the goal of complete tumor removal is more important and appropriate for patients with astrocytomas than oligodendrogliomas.…”

Dynamics of functional MRI and speech function in patients after resection of frontal and temporal lobe tumors

“…В нейрохирургической практике результаты фМРТ широко используются в предоперационной подготовке больных к удалению опухолей доми-нантного полушария для латерализации и локализа-ции речевых зон по отношению к опухоли [13,14]. Предоперационные данные фМРТ используют так-же для прогноза послеоперационного восстановле-ния функции речи [15].…”