A new concept of diffuse (low-grade) glioma surgery
Preservation and even improvement of the quality of life is currently a priority in surgery for gliomas, in addition to the optimization of the extent of resection with significant increase of the overall survival. In this setting, the goal of the present
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Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France 2 Team ‘‘Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors’’, ^pital Saint Eloi, CHU INSERM U1051, Institute for Neuroscience of Montpellier, Ho Montpellier, Montpellier, France With 5 Figures and 1 Table
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Technical and conceptual limitations of functional and oncological neuroimaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Individual intrasurgical cortical mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subpial dissection with vasculature preservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subcortical mapping with preservation of the neural connectivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Motor pathways. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Somatosensory tracts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Optic radiations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Language pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pathways underlying spatial cognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Functional and oncological results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions and perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Abstract Preservation and even improvement of the quality of life is currently a priority in surgery for gliomas, in addition to the optimization of the extent of resection J. D. Pickard et al. (eds.), Advances and Technical Standards in Neurosurgery © Springer-Verlag/Wien 2012
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with significant increase of the overall survival. In this setting, the goal of the present review is to revisit technical aspects of glioma surgery in the lights of new concepts both in the fields of neurooncology and cognitive neurosciences, which recently emerged from translational researches – with special emphasis on diffuse low grade gliomas. Firstly, the vascularisation (arteries and veins) has to be more systematically spared, by performing subpial dissection and by limiting the use of coagulation wit
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