INTRODUCTIONThe aims of this article were to review the role of surgical resection in the management of high-grade gliomas and to determine whether there is any survival benefit from surgical resection.

METHODSA literature review of the influence of surgical resection on outcome was carried out. Relevant original and review papers were obtained through a PubMed search using the following keywords: glioma, resection, prognosis and outcome.

RESULTSPresently, there is a lack of evidence to support a survival benefit with aggressive glioma resection, but this should not detract patients from undergoing surgery as there are many other clinical benefits of glioma excision. In addition, limiting surgical morbidity through the use of adjuvant techniques such as intraoperative magnetic resonance imaging (MRI), functional MRI and awake craniotomy is becoming increasingly important.

CONCLUSIONSIdeally, a randomised controlled trial would be the best way to resolve the issue of whether (and to what extent) surgical resection leads to improvements in patient outcome and survival, but this would not be ethical. The second best option would be well-controlled retrospective studies with a multivariate analysis of all potential confounding factors.

Glioma ; classification ; surgery ; Humans ; Singapore ; Survival Analysis

The demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients' full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.
Brain Mapping ; Brain Neoplasms/surgery* ; Glioma/surgery* ; Humans ; Language ; Multilingualism

The treatment of gliomas is highly individualized. Surgery for gliomas is essentially for histological diagnosis, to alleviate mass effect, and most importantly, to favor longer survival expectancy. During the past two decades, many surgical techniques and adjuvants have been applied to glioma surgery in China, which lead to a rapid development in the field of cerebral glioma surgery. This article broadly and critically reviewed the existing studies on cerebral glioma surgery and to portrait the current status of glioma surgery in China. A literature search was conducted covering major innovative surgical techniques and adjuvants for glioma surgery in China. The following databases were searched: the Pubmed (January 1995 to date); China Knowledge Resource Integrated Database (January 1995 to date) and VIP Database for Chinese Technical Periodicals (January 1995 to date). A selection criterion was established to exclude duplicates and irrelevant studies. The outcome measures were extracted from included studies. A total of 3307 articles were initially searched. After excluded by abstracts and full texts, 69 studies conducted in the mainland of China were included and went through further analysis. The philosophy of surgical strategies for cerebral gliomas in China is undergoing tremendous change. Nowadays Chinese neurosurgeons pay more attention to the postoperative neurofunctional status of the patients. The aim of the glioma surgery is not only the more extensive tumor resection but also the maximal safety of intervention. The well balance of longer overall survival and higher quality of life should be judged with respect to each individual patient.
China ; Glioma ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Neurosurgery

BACKGROUNDReliable early prediction response to therapy and time-to-progression (TTP) remain an important goal of high-grade gliomas (HGGs) research. Proton magnetic resonance spectroscopy ((1)H-MRS) has been applied with variable success in clinical application, and we hypothesize that (1)H-MRS in predictive value should perform well as a marker of TTP in patients treated with radiotherapy (RT) after surgery.

METHODS(1)H-MRS was performed before surgery on 25 patients who had undergone resection of HGGs; then the ratios of lipid/creatine (Lip/Cr) and myo-inositol/creatine (mI/Cr) were determined in the solid tumor. RT response was classified as follows: complete resolution (CR), partial response (PR), stable disease (SD), and progressive disease (PD) by comparison of pre-treatment and post-radiotherapy scans. TTP was defined at the time to radiographic progression by MacDonald criteria. Correlation was evaluated between the ratios of Lip/Cr, mI/Cr and treatment response, TTP. The chi-square test and Pearson correlation test were used for data analyses.

RESULTSMultivariate analysis revealed that the prognostic value of spectroscopic variables was independent of age, sex, WHO histologic grade, extent of surgery, and Karnofsky score (KPS). The correlation between the ratios of lipid/Cr and TTP was significant (r = 0.894, P = 0.000), and between the ratios of mI/Cr and TTP was also significant (r = 0.891, P = 0.000). As predicted, RT response correlated significantly with TTP (r = 0.59, P = 0.002): median TTP was 49.9 days for patients with PD compared with 202.7 days for SD, 208.0 days for PR, and 234.5 days for CR.

CONCLUSIONThe ratios of Lip/Cr and mI/Cr of the solid tumor region before surgery could provide important information in predicting RT response and TTP in patients with HGGs treated by radiation alone after surgery.

Glioma ; radiotherapy ; surgery ; Humans ; Magnetic Resonance Spectroscopy ; methods ; Multivariate Analysis

Precision neurosurgery concept as well as the establishment of it's technical platform, have played essential roles in promoting the modern surgical management of brain gliomas in China.In the past decade,the multidisciplinary integration of medical sciences and technology innovations has significantly promoted the clinical implementation of new imaging and novel navigation technology.With active clinical translational research and practice,precision neurosurgery has developed from "startup prologue" (simple anatomical navigation) to "precision neurosurgery 1.0" (intraoperative MRI with multimodal neuronavigation),followed by "precision neurosurgery 2.0" (informative and systematic upgrading).In the past decade,Chinese researchers have made significant and remarkable achievements in precision neurosurgery through continuous efforts and innovation.In the future,state-of-art technologies such as artificial intelligence on deep learning and machine learning,multimodal real-time navigation,intraoperative optical imaging,and targeted molecular imaging technology will promote the development of precision neurosurgery in a coordinated manner, leading to the advent of "precision neurosurgery 3.0".
Artificial Intelligence ; Brain ; Glioma/surgery* ; Humans ; Neurosurgery ; Neurosurgical Procedures/methods*

OBJECTIVETo investigate the clinical value of high-field-strength intraoperative magnetic resonance imaging (iMRI) combined with optic radiation neuro-navigation for the resection of temporal lobe low-grade gliomas.

METHODSFrom April 2009 to September 2013, 65 patients with temporal lobe low-grade gliomas (WHO grade II) involving optic radiation were operated with iMRI and functional neuro-navigation. Diffusion tensor imaging (DTI) based fiber tracking was used to delineate optic radiation. The reconstructed optic radiations were integrated into a navigation system, in order to achieve intraoperative microscopic-based functional neuro-navigation. iMRI was used to update the images for both optic radiations and residual tumors. Volumetric analyses were performed using 3D Slicer for pre- and intra-operative tumor volumes in all cases. All patients were evaluated for visual field deficits preoperatively and postoperatively. The Student t test was used to evaluate the average rate of extent of resection between groups. Spearman rank correlation analysis was used to assess correlations between predictors and epilepsy prognosis.

RESULTSPreoperative tumor volumes were (78±40) cm3. In 29 cases, iMRI scan detected residual tumor that could be further resected, and extent of resection were increased from 76.2% to 92.7% (t=7.314, P<0.01). In 19 cases (29.2%), gross total resection was accomplished, and iMRI contributed directly to 8 of these cases. Postsurgical follow-up period varied from 13 months to 59 months, mean (33±13) months. Tumor progression were observed in 3 patients, newly developed or deteriorated visual field defects occurred in 4 patients (6.2%). For patients with pre-operative seizures, Engel Class I were achieved for 89.7% of them. Spearman rank correlation analysis revealed that seizure outcome (Engel Class) was related to increased excision of ratio (r=-0.452, P=0.004, 95% CI: -0.636--0.261) and larger tumors (r=0.391, P=0.014, 95% CI: 0.178-0.484).

CONCLUSIONSWith iMRI and functional neuro-navigation, the optic radiation can be accurately located, while extent of resection can be evaluated intra-operatively. This technique is safe and helpful for preservation of visual field for the resection of temporal lobe low-grade gliomas involving optic radiation.

Brain Neoplasms ; pathology ; surgery ; Glioma ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Neuronavigation ; Temporal Lobe ; surgery

OBJECTIVETo evaluate the effectiveness of neuronavigator-guided surgery for the resection of gliomas.

METHODSA total of 80 patients with gliomas underwent surgical treatment under the StealthStation neuronavigator to estimate the extent of the tumors. In 27 cases, the measurements of brain shifts at the dura, cortical surface and lesion margin were recorded during the operations. A technique termed "micro-catheter fence post" was used in superficial gliomas to compensate for brain shift.

RESULTSMean fiducial error and predicted accuracy in the 80 cases were 2.03 mm +/- 0.89 mm and 2.43 mm +/- 0.99 mm, respectively. The shifts at the dura, cortical surface and lesion margin were 3.44 mm +/- 2.39 mm, 7.58 mm +/- 3.75 mm, and 6.55 mm +/- 3.19 mm, respectively. Although neuronavigation revealed residual tumors, operations were discontinued in 5 cases of deep-seated gliomas. In the other 75 cases, total tumor removals were achieved in 62 (82.7%), and subtotal removals were achieved in 13 (17.3%). Post-operation, neurological symptoms were improved or unchanged in 68 cases (85.0%), and worsened in 12 (15.0%). No deaths occurred during the operations and post-operations.

CONCLUSIONSIntraoperative brain shifts mainly contribute to the fail of spatial accuracy during neuronavigator-guided glioma surgery. The "micro-catheter fence post" technique used for glioma surgery is shown to be useful for compensating for intraoperative brain shifts. This technique, thus, contributes to an increase in total tumor removal and a decrease in surgical complications.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; surgery ; Female ; Glioma ; surgery ; Humans ; Male ; Middle Aged ; Neuronavigation ; instrumentation

OBJECTIVE: Neurosurgical technique has recently entered a fantastic era of image guided surgery or neuronavigaton and application of this technology is beginning to have a significant impact on a variety of intracranial procedures. This study purports to investigate the effectiveness of this new technique in its application to the brain tumor surgery. METHODS: We used the BrainLab VectorVision neuronavigation system, which is an intraoperative, imageguided, frameless, and localization system. We operated 220 cases of different brain pathological conditions with its guidance. RESULTS: The mean of target localizing accuracy, mass size, and mass volume were 1.14mm, 3.04x3.78cm, 32.04cc respectively. These cases included 194 microsurgical craniotomies, 21 frameless stereotactic biopsies, 4 endoscopic procedure and 1 catheter placement. The common pathological diagnoses were meningioma in 61 cases, glioma in 59 and metastasis in 45. CONCLUSION: The neuronavigation system has shown to be very effective and user-friendly for routine microsurgical interventions. The application of this technique not only revealed benefits in operative planning, appreciation of anatomy, lesion location, and safety of surgery, but also greatly enhanced surgical confidence. The image guided surgical technology has a great potential to play an important role in contemporary neurosurgery and its various adoptions in practice will be realized in the near future.
Biopsy ; Brain Neoplasms* ; Brain* ; Catheters ; Craniotomy ; Diagnosis ; Glioma ; Meningioma ; Neoplasm Metastasis ; Neuronavigation* ; Neurosurgery ; Surgery, Computer-Assisted

Adult ; Female ; Glioma ; pathology ; surgery ; Humans ; Neoplasms, Multiple Primary ; pathology ; surgery ; Ovarian Neoplasms ; pathology ; surgery ; Peritoneal Neoplasms ; pathology ; surgery ; Teratoma ; pathology ; surgery

No abstract available.
Dose-Response Relationship, Radiation ; Glaucoma, Neovascular/*etiology ; Glioma/*surgery ; Humans ; Optic Nerve Neoplasms/*surgery ; Radiosurgery/*adverse effects