Home > Riviste > Journal of Neurosurgical Sciences > Fascicoli precedenti > Journal of Neurosurgical Sciences 2019 April;63(2) > Journal of Neurosurgical Sciences 2019 April;63(2):135-61

ULTIMO FASCICOLO
 

JOURNAL TOOLS

eTOC
Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Publication history
Estratti
Permessi
Per citare questo articolo

 

REVIEW  CEREBRAL GLIOMA IN HIGHLY ELOQUENT AREAS: MANAGEMENT AND OUTCOME 

Journal of Neurosurgical Sciences 2019 April;63(2):135-61

DOI: 10.23736/S0390-5616.18.04594-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Modern operative nuances for the management of eloquent high-grade gliomas

Martin M. MORTAZAVI 1, 2 , Ghazaleh AHMADI JAZI 1, 2, Mohsen SADATI 1, 2, Kamila ZAKOWICZ 1, 2, Sarvenaz SHEIKH 1, 2, Kianoush KHALILI 2, Farzad H. ADL 1, 2, Muhammad A. TAQI 1, 2, Ha S. NGUYEN 1, 2, R. Shane TUBBS 2, 3

1 California Institute of Neuroscience, Thousand Oaks, CA, USA; 2 National Skull Base Foundation, Thousand Oaks, CA, USA; 3 Seattle Science Foundation, Seattle, WA, USA



INTRODUCTION: Despite advancements in the treatment of high-grade gliomas (HGG), the rate of tumor recurrence is high and survival rate for the patient is low. Gross total resection has shown increased survival but the location of the tumor in the eloquent brain poses significant risk of morbidity. In this report, we focus on modern surgical nuances for resection of tumors located in the eloquent brain.
EVIDENCE ACQUISITION: Research of the literature was conducted using the following search terms: surgical resection of gliomas, high-grade gliomas, and the role of vascular encasement - from 1986-2018. An institutional experience from the first author of this paper was also reviewed for selection of our illustrative cases.
EVIDENCE SYNTHESIS: Gross total resection remains the mainstay of therapy for high-grade gliomas. The resection of the peritumoral FLAIR, when possible, has been associated with increased survival but also has the potential to cause increased morbidity. In the eloquent brain, the resection of the tumor itself is possible if attention is given to the interface of the tumor and brain, or if a safe pseudo-interface is created by the surgeon. Tumor-seeding to the ventricular system needs to be avoided. Devascularization, dissection away from the brain, and retractorless brain surgery are key to successful surgical outcomes. Management of the venous and arterial invasion/encasement are also outlined in this report. Technical aspects are discussed with corresponding videos.
CONCLUSIONS: High-grade gliomas involving eloquent brain areas require a tailored treatment plan. While the medical treatment is undergoing quick evolution, gross total resection still remains one of the key milestones of treatment for improved survival. Surgical techniques play key role. We propose that encasement and/or the invasion of arteries and veins, should be considered equally as important as the eloquent brain when contemplating the resection of gliomas.


KEY WORDS: Glioma - Glioblastoma - Oligodendroglioma - Surgery - Craniotomy

inizio pagina