Onkológia 2/2024

Surgical treatment of diffuse brain gliomas in adults patients

Infiltrative brain gliomas in adults are characterized by diffuse growth with frequent finding of functional brain tissue within the tumor mass. Pseudoborders of brain gliomas are often indistinguishable from the healthy brain tissue. During the microsurgical resection of gliomas growing within or adjacent to eloquent brain areas, there is a risk of damage to these structures and subsequent permanent neurological deficit. Due to aforementioned reason, in addition to the preoperative identification of cortical and subcortical eloquent structures, precise microsurgical technique, neuronavigation, various intraoperative imaging modalities, electrophysiological neuromonitoring modalities and “awake” surgery are necessary for successful glioma resections. In recent years, it has become an important goal to preserve not only “only” neurological functions whose deficits are already visible during the basic neurological examination (e.g. speech and language functions, motor functions, visual functions, etc.), but also to preserve the cognitive functions of the patient. The goal of neurosurgical brain glioma surgery must be so-called “onco-functional balance” - i.e. extensive resection of glioma tissue associated with longer overall survival, but at the same time preservation of brain structures that allow (as much as possible) a full social and working life of the patient.

Keywords: glioma; „awake“ surgery; direct electrical stimulation; navigation; ultrasound