Lessons from brain mapping in surgery for low-grade glioma: insights into associations between tumour and brain plasticity.
Surgical treatment of low-grade gliomas (LGGs) aims to maximise the amount of tumour tissue resected, while minimising the risk of functional sequelae. In this review I address the issue of how to reconcile these two conflicting goals. First, I review the natural history of LGG-growth, invasion, and anaplastic transformation. Second, I discuss the contribution of new techniques, such as functional mapping, to our understanding of brain reorganisation in response to progressive growth of LGG. Third, I consider the clinical implications of interactions between tumour progression and brain plasticity. In particular, I show how longitudinal studies (preoperative, intraoperative, and postoperative) could allow us to optimise the surgical risk-to-benefit ratios. I will also discuss controversial issues such as defining surgical indications for LGGs, predicting the risk of postoperative deficit, aspects of operative surgical neuro-oncology (eg, preoperative planning and preservation of functional areas and tracts), and postoperative functional recovery.
Duffau
Hugues
H
Department of Neurosurgery, INSERM U678, Hôpital Salpêtrière, Paris, France. hugues.duffau@psl.ap-hop-paris.fr
D001921:Brain / Q000502:physiology* / Q000503:physiopathology / Q000601:surgery; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D004569:Electroencephalography; D005910:Glioma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D016343:Monitoring, Intraoperative; D009473:Neuronal Plasticity; D049268:Positron-Emission Tomography