Surgery for gliomas

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Abstract
To assess selected papers on surgery for glioma for their impact on clinical practice. Recent developments in surgical neuro-oncology for gliomas have centred around technological advances that enable the fusion of preoperative structural and functional imaging datasets, the use of intraoperative magnetic resonance imaging scanning, and awake craniotomy and cortical stimulation as means to maximize glioma resection, minimize postoperative morbidity, and improve survival times. Correlations of preoperative functional imaging information with operative awake neurophysiological findings are good, but the problem of brain shift during resective surgery remains problematical and is a cogent reason for using intraoperative magnetic resonance imaging. Two reviews showed little evidence to support the concept that 'aggressive' resection of both high and low-grade gliomas significantly prolongs the life of patients. Attempting radical excision of these tumours can have unfortunate consequences in eloquent brain regions, particularly as functional studies confirm brain activity within the limits of many gliomas. Despite amazing technical advances in the investigation, assessment and surgical management of patients with glioma, the lack of an evidence basis for 'aggressive' resective management continues to pose dilemmas for surgeons.

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