A new concept of diffuse (low-grade) glioma surgery
Abstract
Preservation and even improvement of the quality of life is currently a priority in surgery for gliomas, in addition to the optimization of the extent of resection with significant increase of the overall survival. In this setting, the goal of the present review is to revisit technical aspects of glioma surgery in the lights of new concepts both in the fields of neurooncology and cognitive neurosciences, which recently emerged from translational researches - with special emphasis on diffuse low grade gliomas.Firstly, the vascularisation (arteries and veins) has to be more systematically spared, by performing subpial dissection and by limiting the use of coagulation within the brain. Secondly, individual cortical as well as subcortical mapping must be more regularly considered, with the aim of better understanding and preserving the white matter pathways underlying the functional connectivity - even in presumed "non-eloquent areas", to perform "supra-complete" resection.Therefore, brain surgeons should change their state of mind, in order to operate the nervous system involved by a chronic tumoral disease (and no more by operating a tumor mass within the brain). In other words, the neurosurgeon should see first the brain, and not the glioma, to adapt his surgical procedure to the three-dimensional anatomo-functional organization of each patient. It implies that brain surgeon must change his technique within the central nervous system, which has to be different from the surgical technique outside the brain. This perspective seems to represent the best way to build a modern and personalized "functional surgical neurooncology".
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More recent studies have suggested that a hierarchical topology is involved in restoring function after lesions.
“more recent studies have suggested that a hierarchical topology is involved in restoring function after lesions.33”
From Graph theory analysis of complex brain networks: new concepts in brain mapping applied to neurosurgery (2016) · cites this paper as [33]
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Trimble, G., McStravick, C., Farling, P. A., Megaw, K., McKinstry, S., Smyth, G., Law, G., Courtney, H., Quigley, G., & Flannery, T. J. (2015) · British Journal of Neurosurgery · doi:10.3109/02688697.2015.1054354 · Cited by 27 · see citing works
Ghadimi, K., Abbas, I., Karandish, A., Crisman, C., Eskandar, E. N., & Kobets, A. J. (2025) · Current Oncology · doi:10.3390/curroncol32030152 · Cited by 26 · see citing works
Hotspots of small strokes in glioma surgery: an overlooked risk?
Loit, M.-P., Rheault, F., Gayat, É., Poisson, I., Froelich, S. C., Zhi, N., Velut, S., & Mandonnet, E. (2018) · Acta Neurochirurgica · doi:10.1007/s00701-018-3717-3 · Cited by 22 · see citing works
Spena, G., Panciani, P. P., & Fontanella, M. M. (2014) · Neurosurgical Review · doi:10.1007/s10143-014-0578-y · Cited by 21 · see citing works
Duffau, H. (2023) · Journal of neurosurgery · doi:10.3171/2023.6.jns231048 · Cited by 20 · see citing works
Self-citationDuffau, H. (2013) · Acta Neurochirurgica · doi:10.1007/s00701-013-1807-9 · Cited by 21 · see citing works
Self-citationBrain Plasticity and Reorganization Before, During, and After Glioma Resection
Duffau, H. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-47660-7.00018-5 · Cited by 18 · see citing works
Self-citationLi, T., Bai, H., Wang, G., Wang, W., Lin, J., Gao, H., Wang, L., Xia, L., & Xie, X. (2015) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2015.2359 · Cited by 15 · see citing works
Awake craniotomy for epilepsy surgery on eloquent speech areas: a single‐centre experience
Korkar, G. H., Isnard, J., Montavont, A., Catenoix, H., Rheims, S., & Guénot, M. (2021) · Epileptic Disorders · doi:10.1684/epd.2021.1275 · Cited by 15 · see citing works
Primo non nocere or maximum survival in grade 2 gliomas? A medical ethical question
Brennum, J., Maier, C. M., Almdal, K., Engelmann, C. M., & Gjerris, M. (2014) · Acta Neurochirurgica · doi:10.1007/s00701-014-2304-5 · Cited by 15 · see citing works
Matsuda, R., Moritz‐Gasser, S., Duvaux, S., Coello, A. F., Martinoni, M., & Duffau, H. (2014) · Acta Neurochirurgica · doi:10.1007/s00701-014-2003-2 · Cited by 14 · see citing works
Self-citationBoissonneau, S., & Duffau, H. (2017) · Expert Review of Anticancer Therapy · doi:10.1080/14737140.2017.1342537 · Cited by 13 · see citing works
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Das, K. K., Gosal, J. S., Khatri, D., Singh, A., Datta, A., Kumar, A., Bhaisora, K. S., Verma, P. K., Srivastava, A. K., Jaiswal, A., et al. (2022) · Neurology India · doi:10.4103/0028-3886.349642 · Cited by 8 · see citing works
Follow-Up and Treatment of Patients with Coexisting Brain Tumor and Intracranial Aneurysm
Lee, H. S., Park, W., Kim, Y., Park, J. C., Ahn, J.-S., & Kim, J. H. (2019) · World Neurosurgery · doi:10.1016/j.wneu.2019.05.023 · Cited by 8 · see citing works
Acharya, S., Lavrador, J. P., Sekhon, P. P., Visagan, R., Jung, J., GULLAN, R. W., Vergani, F., Bhangoo, R. S., & Ashkan, K. (2021) · World Neurosurgery · doi:10.1016/j.wneu.2021.03.101 · Cited by 7 · see citing works
Awake craniotomy: analysis of complicated cases
Kulikov, A. S., Kobyakov, G. L., Гаврилов, А. Г., & Lubnin, А. Y. (2015) · Burdenko s Journal of Neurosurgery · doi:10.17116/neiro201579615-21 · Cited by 9 · see citing works
Perioperative functional neuroimaging of gliomas in eloquent brain areas
Mellerio, C., Charron, S., Lion, S., Roca, P., Kuchcinski, G., Legrand, L., Edjlali, M., Naggara, O. N., Méder, J.-F., Pallud, J., et al. (2017) · Neurochirurgie · doi:10.1016/j.neuchi.2016.10.012 · Cited by 6 · see citing works
Bresson, D., Madadaki, C., Poisson, I., Habas, C., & Mandonnet, E. (2013) · Neurochirurgie · doi:10.1016/j.neuchi.2013.08.002 · Cited by 7 · see citing works
Surgery for Diffuse Low-Grade Gliomas (DLGG) Oncological Considerations
Duffau, H. (2013) · Springer eBooks · doi:10.1007/978-1-4471-2213-5_23 · Cited by 5 · see citing works
Self-citationBhatti, A. A., Jakhrani, N. K., & Parekh, M. A. (2018) · Asian Journal of Neurosurgery · doi:10.4103/ajns.ajns_144_16 · Cited by 5 · see citing works
Duffau, H. (2012) · World Neurosurgery · doi:10.1016/j.wneu.2012.10.025 · Cited by 4 · see citing works
Self-citationBasile, L., Sato, J. R., Pasquini, H. A., Lozano, M. D., Nucci, M. P., Velasques, B., Ribeiro, P. F. M., Ramos, R. T., & Anghina, R. (2015) · PLoS ONE · doi:10.1371/journal.pone.0128343 · Cited by 4 · see citing works
Advances and Technical Standards in Neurosurgery
Schramm, J. (2015) · Advances and technical standards in neurosurgery · doi:10.1007/978-3-319-21359-0 · Cited by 4 · see citing works
Is There a Place for Endoscopy in Glioma Surgery?
Duffau, H. (2014) · World Neurosurgery · doi:10.1016/j.wneu.2014.08.037 · Cited by 3 · see citing works
Self-citationDuffau, H. (2013) · Springer eBooks · doi:10.1007/978-1-4471-2213-5_1 · Cited by 2 · see citing works
Self-citationInteractions Between Diffuse Low-Grade Glioma (DLGG) and Brain Plasticity
Duffau, H. (2013) · Springer eBooks · doi:10.1007/978-1-4471-2213-5_22 · Cited by 2 · see citing works
Self-citationA Concept Car or an All-road Car To Drive All Along Glioma Resection?
Pallud, J. (2015) · World Neurosurgery · doi:10.1016/j.wneu.2015.02.022 · Cited by 2 · see citing works
Surgery for Diffuse Low-Grade Gliomas (DLGG) Functional Ouctomes
Duffau, H. (2017) · Springer eBooks · doi:10.1007/978-3-319-55466-2_24 · Cited by 1 · see citing works
Self-citationLi, K., & Moskowitz, H. S. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.012 · Cited by 1 · see citing works
Grande, E., Ciavarro, M., Bevacqua, G., Baldassarre, A., Committeri, G., & Esposito, V. (2025) · Cortex · doi:10.1016/j.cortex.2025.07.016 · Cited by 1 · see citing works
Surgery for Diffuse Low-Grade Gliomas (DLGG) Functional Considerations
Duffau, H. (2013) · Springer eBooks · doi:10.1007/978-1-4471-2213-5_24 · Cited by 1 · see citing works
Self-citationCombined Endoscopic Endonasal and Transcranial Approach to Complex Intracranial Lesions
Nuru, M. O., Chandra, A., & Aghi, M. K. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.006 · Cited by 1 · see citing works
New Individualized Strategies in DLGG
Duffau, H., & Taillandier, L. (2013) · Springer eBooks · doi:10.1007/978-1-4471-2213-5_27 · Cited by 1 · see citing works
Self-citationMini-strokes after awake surgery for glioma resection: are there anesthesia related factors?
Walter, T., Foray, G., Mohammed-Brahim, N., Levé, C., Mandonnet, E., & Gayat, É. (2024) · Acta Neurochirurgica · doi:10.1007/s00701-024-06195-8 · Cited by 1 · see citing works
Surgery for Diffuse Low-Grade Gliomas (DLGG) Oncological Outcomes
Duffau, H. (2017) · Springer eBooks · doi:10.1007/978-3-319-55466-2_23 · Cited by 1 · see citing works
Self-citationSurgical Resection Techniques of Insular Gliomas
Tsitlakidis, A., & Foroglou, N. (2018) · Springer eBooks · doi:10.1007/978-3-319-95918-4_23 · Cited by 1 · see citing works
Awake Craniotomies for Neoplasms Involving Language Networks
Duffau, H. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-811783-5.00019-7 · Cited by 1 · see citing works
Self-citationSato, H., Fukushima, T., & Friedman, A. H. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.017 · Cited by 1 · see citing works
L’épilepsie associée aux tumeurs cérébrales
Huberfeld, G., & Pallud, J. (2015) · Pratique Neurologique - FMC · doi:10.1016/j.praneu.2014.12.010
Duffau, H. (2013) · Springer eBooks · doi:10.1007/978-1-4471-2213-5_31
Self-citationInteractions Between Diffuse Low-Grade Glioma (DLGG), Brain Connectome and Neuroplasticity
Duffau, H. (2017) · Springer eBooks · doi:10.1007/978-3-319-55466-2_22
Self-citationSurgery of Insular Diffuse Low-Grade Gliomas
Michaud, K., & Duffau, H. (2018) · Springer eBooks · doi:10.1007/978-3-319-75468-0_28
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Ibrahim, G., Simry, H. A. M., Darwish, A. A., Hamada, S., & Hefny, S. (2020) · Ain Shams Medical Journal · doi:10.21608/asmj.2020.125671
Ivanova, N. E., Карягина, М. В., Alekseeva, T. M., & Efimova, M. Y. (2021) · Современные проблемы науки и образования · doi:10.17513/spno.30646
Combined Transsylvian-Subtemporal Approach to Anterior Circulation and Basilar Apex Aneurysms
Malcolm, J. G., & Barrow, D. L. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.022
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Transchoroidal, Subchoroidal, and Combined Approaches to the Third Ventricle
Aljuboori, Z., Salih, H. R., Williams, B. J., & Ding, D. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.009
Combined Endonasal and Transoral Endoscopic Approach to the Craniovertebral Junction
Kimple, A. J., Thorp, B. D., & Zanation, A. M. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.004
Combined Retrosigmoid and Limited Anterior Petrosectomy (“Reverse Petrosectomy”)
Gompel, J. J. V. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.015
Combined Keyhole Paramedian Supracerebellar-Transtentorial Approach
Carr, S., Goyal, A., & Teo, C. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.018
Combined Endonasal and Transorbital Approach
Lubbe, D. E., & Mustak, H. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.003
Guazzo, E., Solares, A., & Panizza, B. J. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.013
Combined Retrosigmoid and Orbitozygomatic Approach
Mooney, M. A., & Spetzler, R. F. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.014
Hybrid/Combined Strategies for Vestibular Schwannomas
Theodosopoulos, P. V. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.008
Combined Transcranial Approach for Tumor Resection and Anterior Circulation Vascular Bypass
Vasudevan, K., Rindler, R. S., Erwood, A. M., & Pradilla, G. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.007
Combined Multi-portal “Pull-Through” Keyhole Craniotomy
Briggs, R. G., Conner, A. K., Palejwala, A. H., Pelargos, P. E., Ernst, G. L., O’Connor, K. P., Glenn, C. A., & Sughrue, M. E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.019
Combined Endonasal Transethmoidal, Transcribriform, and Endoscope-Assisted Supraorbital Craniotomy
Arko, L., Morgenstern, P. F., & Schwartz, T. H. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.002
Transbasal and Transfacial Approach for Paranasal and Anterior Cranial Fossa Tumors
Link, M. J., & Moore, E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.011
Combined Microsurgical and Endovascular Treatment of Cerebrovascular and Skull Base Pathology
Howard, B. M., Grossberg, J. A., Barrow, D. L., & Cawley, C. M. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.021
Combined Orbitofrontal Craniotomy and Direct Orbital Decompression
Mehta, V. J., Quarante, G. L. H., Garrity, J. A., & Mettu, P. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.010
Combined Endoscopic Endonasal and Transcervical Approach
El‐Sayed, I. H., Schoppy, D. W., & Strohl, M. P. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.005
Combined Keyhole Craniotomies for Multifocal or Multiple Lesions
Funari, A., Echt, M., & Agarwal, V. J. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.020
Integrated Management of Complex Intracranial Lesions
(2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610
Agarwal, V. J. (2021) · doi:10.1017/9781108908610.001
Agarwal, V. J. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108908610.023
RESULTS OF TREATMENT OF GLIAL BRAIN TUMORS
Гурезович, А. Р., KOROTKEVICH, E. A., & Сидорович, Р. Р. (2017) · Avicenna Bulletin · doi:10.25005/2074-0581-2017-19-4-476-481
Ramensky, V. V., Улитин, А. Ю., Kalmens, V. Y., Salomatina, T. A., & Андреев, Е. В. (2023) · Неврология и нейрохирургия Восточная Европа · doi:10.34883/pi.2023.13.3.040
IDH status shapes glioma oncotopy: voxel-wise mapping of 644 adult diffuse gliomas
Garhöfer, F., Yun, Y. C., Wolf, S., Holz, K., Jende, J. M. E., Hohmann, A., Vollmuth, P., Bendszus, M., Santarosa, C., Lövblad, K., et al. (2026) · Neuroradiology · doi:10.1007/s00234-026-03991-0
Leisure-related cognitive reserve and postoperative cognitive outcomes after brain tumor surgery
Kinoshita, M., Ebina, K., Domoto, C., Nakajima, R., Nakada, M., & Matsui, M. (2026) · Neuro-Oncology Advances · doi:10.1093/noajnl/vdag175
- Authors
- Duffau, H.
- Affiliations
- Centre Hospitalier Universitaire de Montpellier (FR)
- Corresponding author
- Duffau, H.
- ORCID
- Duffau, H.
- Venue
- Advances and Technical Standards in Neurosurgery
- Publisher
- Springer Vienna
- Published
- 2012
- Volume
- 38
- Pages
- 3-27
- ISSN
- 0095-4829 (ISSN-L)
- OpenAlex
- W30509310
- Cited by
- 91
- References
- 79
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 27 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 12 · 2016: 2 · 2015: 10 · 2014: 7 · 2013: 12 · 2012: 2
- FWCI
- 21.14
- Type
- book chapter
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Advances and technical standards in neurosurgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Keywords
- diffuse low-grade glioma, glioma surgery, extent of resection, functional brain mapping, white matter preservation, functional connectivity, quality of life, cognitive neuroscience
- MeSH terms
- Brain Mapping, Brain Neoplasms, Glioma, Humans, Quality of Life, Neurosurgical Procedures
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