Because diffuse low-grade glioma (DLGG) is constantly migrating in the brain until malignant transformation, the historic wait-and-watch attitude was replaced by an early therapeutic management. Moreover, advances in cognitive neurosciences allowed an improved understanding of neuroplasticity reactional to DLGG growth. Here, the aim is to reevaluate the role of surgery regarding both oncological and functional outcomes.
Recent data evidenced the significant benefit of maximal well tolerated resection on survival and quality of life (QoL). By removing a diffuse neoplastic disease up to eloquent neural networks identified by intraoperative awake mapping and cognitive monitoring, overall survival is about the double compared with biopsy, whereas the rate of severe persistent deficits was significantly reduced. Postoperative QoL may even be improved owing to functional rehabilitation and epilepsy control.
Early and functional mapping-guided surgery is currently the first treatment in DLGG. Surgical resection(s) should be integrated in a global personalized management that must be tailored to the brain connectome of each patient. To optimize the oncofunctional balance, the next step is a screening, to detect and to treat DLGG patients earlier, and to increase the rate of ‘supramarginal excision’ in the setting of a ‘prophylactic connectomal neurooncological surgery’.
aDepartment of Neurosurgery, Gui de Chauliac Hospital
bInstitute for Neuroscience of Montpellier, INSERM U1051, Team ‘Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors’, Saint Eloi Hospital, Montpellier University Medical Center, Montpellier, France
Correspondence to Professor Hugues Duffau, MD, PhD, Department of Neurosurgery, Gui de Chauliac hospital, CHU Montpellier, 80, Avenue Augustin Fliche, Montpellier 34295, France. Tel: +33 0 4 67 33 66 12; fax: +33 0 4 67 33 69 12; e-mail: firstname.lastname@example.org