Surgical resection of incidental diffuse gliomas involving eloquent brain areas. Rationale, functional, epileptological and oncological outcomes.
OBJECTIVE
Incidentally discovered diffuse low-grade gliomas progress in a fashion similar to their symptomatic counterparts. Their early detection allows more effective pre-emptive and individualized oncological treatment. We assessed the safety and efficacy of maximal safe resection according to functional boundaries for incidental diffuse low-grade gliomas in eloquent areas.


METHODS
Two-centre retrospective series of adult patients with incidental diffuse low-grade gliomas located within/close to eloquent areas in the dominant hemisphere, treated with maximal surgical resection according to functional boundaries under intraoperative functional cortico-subcortical monitoring under awake conditions, and with a minimal follow-up of 24months.


RESULTS
The series included 19 patients (8 men, 11 women) with no preoperative neurological deficit but with a radiologically enlarged glioma. No intraoperative seizure, postoperative infection, haematoma or wound-healing problem was observed. In the immediate postsurgical period, a transient neurological worsening occurred in 10 patients. The resection (mean rate 96.4%; range, 82.4-100) was supratotal in 5 cases, total in 5 cases, subtotal in 7 cases, and partial in 2 cases. Six months after surgery, all patients recovered after functional rehabilitation, with no permanent neurological deficit, Karnofsky Performance Status was 100 (except for one patient who received early postoperative radiotherapy) and no seizures were observed. The survival without progression requiring oncological treatment was significantly longer in patients with a total/supratotal resection than in patients with a partial/subtotal resection.


CONCLUSIONS
These results suggest the reproducibility, safety, and effectiveness of an early maximal functionally based resection within cortico-subcortical functional boundaries for incidental diffuse low-grade gliomas in adults in centres hyperspecialized in surgical neuro-oncology.
Department of Neurosurgery, Onofre Lopes University Hospital, Rio Grande do Norte Federal University, Natal, RN, Brazil; Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
G L O
GLO
Lima
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
E
E
Dezamis
Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom.
R
R
Corns
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
O
O
Rigaux-Viode
Inserm U1051, Institute for Neuroscience of Montpellier, Montpellier, France.
S
S
Moritz-Gasser
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
A
A
Roux
Réseau d'étude des gliomes (REG), Groland, France; Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Inserm U1051, Institute for Neuroscience of Montpellier, Montpellier, France.
H
H
Duffau
Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674 Paris cedex 14, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Réseau d'étude des gliomes (REG), Groland, France. Electronic address: johanpallud@hotmail.com.
J
J
Pallud
D000328:Adult; D001921:Brain / Q000601:surgery; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004558:Electric Stimulation / Q000379:methods; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology
Awake craniotomy; Diffuse low-grade glioma; Incidental; Outcomes; Surgery