Brain Mapping as Helpful Tool in Brain Glioma Surgical Treatment-Toward the "Perfect Surgery"?

Abstract

Gliomas are the most common primary malignant brain tumours in adults, representing nearly 80%, with poor prognosis in their high-grade forms. Several variables positively affect the prognosis of patients with high-grade glioma: young age, tumour location, radiological features, recurrence, and the opportunity to perform post-operative adjuvant therapy. Low-grade gliomas are slow-growing brain neoplasms of adolescence and young-adulthood, preferentially involving functional areas, particularly the eloquent ones. It has been demonstrated that early surgery and higher extent rate ensure overall longer survival time regardless of tumour grading, but nowadays, functional preservation that is as complete as possible is imperative. To achieve the best surgical results, along with the best functional results, intraoperative mapping and monitoring of brain functions, as well as different anaesthesiology protocols for awake surgery are nowadays being widely adopted. We report on our experience at our institution with 28 patients affected by malignant brain tumours who underwent brain mapping-aided surgical resection of neoplasm: 20 patients underwent awake surgical resection and 8 patients underwent asleep surgical resection. An analysis of the results and a review of the literature has been performed.

Keywords: asleep surgery; awake surgery; brain mapping; brain tumour; extent of resection; high grade glioma; low grade glioma.

Figure 1

Anatomical MRI scan showing right fronto-opercular diffuse low-grade glioma.

Figure 2

Neuronavigation system adopted at our Institution.

Figure 3

Intra-operative picture showing Broca’s area (number 5) identified by direct electrical stimulation.

Figure 4

Intra-operative picture showing Broca’s area (number 5) and inferior fronto-occipital fascicle (IFOF) (number 8) identified by direct electrical stimulation.

Figure 5

Post-operative anatomical MRI.