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Recent Surgical Management of Gliomas

  • Chapter
Glioma

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 746))

Abstract

Refinement of neurosurgical technique has enabled safer operations with more aggressive outcomes. One cornerstone of modern-day practice is the utilization of intraoperative stimulation mapping. In addition to identifying critical motor pathways, this technique can be adapted to reliable identify language pathways, as well. Given the individual variability of cortical language localization, such awake language mapping is essential to minimize language deficits following tumor resection. Our experience suggests that cortical language mapping is a safe and efficient adjunct to optimize tumor resection while preserving essential language sites, even in the setting of negative mapping data. However, the value of maximizing glioma resections remains surprisingly unclear, as there is no general consensus in the literature regarding the efficacy of extent of glioma resection in improving patient outcome. While the importance of resection in obtaining tissue diagnosis and to alleviate symptoms is clear, a lack of Class I evidence prevents similar certainty in assessing the influence of extent of resection. Beyond an analysis of modern intraoperative mapping techniques, we examine every major clinical publication since 1990 on the role of extent of resection in glioma outcome. The mounting evidence suggests that, despite persistent limitations in the quality of available studies, a more extensive surgical resection is associated with longer life expectancy for both low-grade and high-grade gliomas.

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  1. Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA

    Nader Sanai & Mitchel S. Berger

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  1. Nader Sanai
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Correspondence to Nader Sanai .

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  1. Kyoto Prefectural University of Medicine, Kyoto, Japan

    Ryuya Yamanaka MD, PhD

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Sanai, N., Berger, M.S. (2012). Recent Surgical Management of Gliomas. In: Yamanaka, R. (eds) Glioma. Advances in Experimental Medicine and Biology, vol 746. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3146-6_2

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