New perspective on low-level glioma removal

Background
diffuse low-level glioma (DLGG) continues to migrate throughout the brain until evil changes, so early treatment has replaced traditional follow-up observationsThe study of cognitive neuroscience has deepened the understanding of neuroplasticity caused by DLGG growthHugues Duffau of montpellier medical center in France re-evaluates the role of surgery in DLGG therapy and neurofunctional outcomes, published in the November 2018 issue of Current Opinion Oncologythe results of the study
if the scope of surgical excision (EOR) is not objectively evaluated, the tumor cells remaining in the tumor boundary are underestimatedresulting in a large difference in overall postoperative survival (OS) in Patients with DLGGnotably, EOR large and OS are not associated with tumor molecular expression spectrumhad thought that a better postoperative OS may be a curative excision of DLGG with a good prognosis genetic marker, such as isocitric acid dehydrogenase (IDH) mutation or 1p19q deletionHowever, a study of 200 DLGG patients showed that surgical excision rates were not associated with the expression of molecular markers, strongly supporting the positive effects of surgeryearly and maximum range excision therapy is the gold standard for DLGG therapytherefore, biopsy should no longer be used for patients with DLGG unless a complete excision cannot be performedSince the recurrence of low-level gliomas is common, re-surgery must be considered an OS-related independent prognosisDLGG surgical removal has two goals, namely, extending OS and retaining nerve functionThe intraoperative cortical electrical stimulation combined with real-time neurocognitive monitoring of the surgical wake-up brain function positioning, can not only protect nerve function, but also improve the quality of life of patientsThis imaging-led glioma excision method to the removal method based on protective nerve function can significantly improve the prognosis of patientsIt has been shown that during DLGG surgery, patients with cortical electrical stimulation can be discharged early, while significantly reducing the incidence of long-term neurodysfunction early use of functionally positional tumor removal surgery is the preferred treatment in DLGG therapy In clinical practice, the tumor EOR on the MRI-T2-weighted FLAIR sequence must be objectively measured before and after each tumor removal, and the neuropsychological function of the patient must be evaluated At the same time, rehabilitation training for cognitive function in the early postoperative period is recommended In order to better protect nerve function, early diagnosis and treatment of DLGG patients should be screened for "preventive, brain-network-based protection of the super-range tumor removal surgery." Group draft Qiu Tianming, draught physician Fudan University affiliated Huashan Hospital compilation Ma Chenkai University of Melbourne review Qiu Tianming attending physician Fudan University affiliated Huashan Hospital final Professor Chen Qicheng "Outside Information" editor-in-chief Fudan University affiliated Huashan Hospital