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Cited by 71Glioma Diagnosis and TreatmentAdvanced Neuroimaging Techniques and ApplicationsMeningioma and schwannoma management

Resection of gliomas deemed inoperable by neurosurgeons based on preoperative imaging studies

Southwell, Derek G., Birk, Harjus S., Han, Seunggu J., Li, Jing, Sall, Jeffrey W., Berger, Mitchel S.·2018·Journal of Neurosurgery
DOI 10.3171/2017.5.jns17166
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Abstract

OBJECTIVE Maximal safe resection is a primary objective in the management of gliomas. Despite this objective, surgeons and referring physicians may, on the basis of radiological studies alone, assume a glioma to be unresectable. Because imaging studies, including functional MRI, may not localize brain functions (such as language) with high fidelity, this simplistic approach may exclude some patients from what could be a safe resection. Intraoperative direct electrical stimulation (DES) allows for the accurate localization of functional areas, thereby enabling maximal resection of tumors, including those that may appear inoperable based solely on radiological studies. In this paper the authors describe the extent of resection (EOR) and functional outcomes following resections of tumors deemed inoperable by referring physicians and neurosurgeons. METHODS The authors retrospectively examined the cases of 58 adult patients who underwent glioma resection within 6 months of undergoing a brain biopsy of the same lesion at an outside hospital. All patients exhibited unifocal supratentorial disease and preoperative Karnofsky Performance Scale scores ≥ 70. The EOR and 6-month functional outcomes for this population were characterized. RESULTS Intraoperative DES mapping was performed on 96.6% (56 of 58) of patients. Nearly half of the patients (46.6%, 27 of 58) underwent an awake surgical procedure with DES. Overall, the mean EOR was 87.6% ± 13.6% (range 39.0%-100%). Gross-total resecti…

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  • A common location of "eloquent" brain areas across patients is inaccurate, given functional compensation and individual variation.

    “However, considering the potential for functional compensation and the presence of individual variation, a common location of “eloquent” areas across patients seems inaccurate (Southwell et al., 2017).”

    From Quantitative mapping of the brain’s structural connectivity using diffusion MRI tractography: A review (2022) · cites this paper as Southwell et al., 2017

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Authors
Southwell, D. G., Birk, H. S., Han, S. J., Li, J., Sall, J. W., & Berger, M. S.
Affiliations
  • Departments of Neurological Surgery and
  • University of California, San Francisco (US)
  • Anesthesia and Perioperative Care, and
Corresponding author
Southwell, Derek G.
ORCID
Venue
Journal of Neurosurgery
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2018-09
Volume
129
Issue
3
Pages
567-575
ISSN
  • 0022-3085 (ISSN-L)
  • 1933-0693
DOI
10.3171/2017.5.jns17166
OpenAlex
W2767301253
Cited by
71
References
50
Citations by year
2026: 3 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 12 · 2021: 10 · 2020: 16 · 2019: 5 · 2018: 6
FWCI
4.24
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of 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 › Epidemiology › Meningioma and schwannoma management
Keywords
glioma, extent of resection, functional MRI, functional brain mapping, awake craniotomy, language mapping, unresectable tumors, residual neurological deficits, functional outcome, brain biopsy, supratentorial glioma, partial resection, gross total resection, preoperative imaging limitations, functional neurosurgery
MeSH terms
Intersectoral Collaboration, Adult, Aged, Biopsy, Brain, Brain Mapping, Electric Stimulation, Female, Follow-Up Studies, Glioma, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Postoperative Complications, Preoperative Care, Retrospective Studies, Supratentorial Neoplasms, Procedural Sedation, Karnofsky Performance Status, Interdisciplinary Communication, Young Adult

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