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


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.


CONCLUSIONS
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.
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Ahmed
A
Abdullah
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Hisham
H
El Shitany
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Waleed
W
Abbass
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Amr
A
Safwat
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Amr K
AK
Elsamman
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Ehab
E
El Refaee
Craniometric points; eloquent areas; functional magnetic resonance imaging; glioma; low-grade glioma; surgery
Acta Neurochir (Wien). 2013 Jul;155(7):1301-8
23689968
Cancer. 1994 Sep 15;74(6):1784-91
8082081
Ann Acad Med Singapore. 2007 May;36(5):358-63
17549284
Neurosurgery. 2010 Jan;66(1):113-20
19935438
J Clin Neurophysiol. 2004 May-Jun;21(3):180-91
15375348
J Neurosurg. 2003 Apr;98(4):764-78
12691401
Stereotact Funct Neurosurg. 1992;58(1-4):153-61
1439333
Neurosurgery. 2006 Oct;59(4 Suppl 2):ONS177-210; discussion ONS210-1
17041489
Neurosurgery. 2010 Jun;66(6):1074-84; discussion 1084
20386138
Eur J Anaesthesiol. 2009 Nov;26(11):906-12
19617839
J Neurosurg. 2009 Aug;111(2):203-10
19267536
Cancer. 2005 Mar 15;103(6):1227-33
15690327
Acta Neurochir (Wien). 2010 Nov;152(11):1835-46
20730457
Lancet Neurol. 2005 Aug;4(8):476-86
16033690
Mayo Clin Proc. 2001 Jul;76(7):677-87
11444399
J Neurol Neurosurg Psychiatry. 2003 Jul;74(7):901-7
12810776
Neurol Med Chir (Tokyo). 2005 Oct;45(10):501-10; discussion 510-1
16247235
PLoS One. 2013 Dec 05;8(12):e80916
24339890
Neuroscientist. 2004 Apr;10 (2):163-73
15070490
Neurosurgery. 2007 Jan;60(1):67-80; discussion 80-2
17228254
World Neurosurg. 2014 Jul-Aug;82(1-2):e299-309
24560709
Acta Neurochir Suppl. 2011;109:43-8
20960319