Surgical resection of incidental diffuse gliomas involving eloquent brain areas. Rationale, functional, epileptological and oncological outcomes

摘要: Abstract Objective Incidentally discovered diffuse low-grade gliomas progress in a fashion similar to their symptomatic counterparts. Their early detection allows more effective pre-emptive and individualized oncological treatment. We assessed the safety efficacy of maximal safe resection according functional boundaries for incidental eloquent areas. Material methods Two-centre retrospective series adult patients with located within/close areas dominant hemisphere, treated surgical under intraoperative cortico-subcortical monitoring awake conditions, minimal follow-up 24 months. Results The included 19 (8 men, 11 women) no preoperative neurological deficit but radiologically enlarged glioma. No seizure, postoperative infection, haematoma or wound-healing problem was observed. In immediate postsurgical period, transient worsening occurred 10 patients. (mean rate 96.4%; range, 82.4–100) supratotal 5 cases, total subtotal 7 partial 2 cases. Six months after surgery, all recovered rehabilitation, permanent deficit, Karnofsky Performance Status 100 (except one patient who received radiotherapy) seizures were survival without progression requiring treatment significantly longer total/supratotal than partial/subtotal resection. Conclusions These results suggest reproducibility, safety, effectiveness an functionally based within adults centres hyperspecialized neuro-oncology.