Adult Low-grade Gliomas-Hugues Duffau, MD Video

Video Transcription
Video Summary
The video is a presentation about the importance of early surgery and maximum safe resection in diffuse low-grade glioma. The speaker discusses the new philosophy in oncology, which emphasizes the need for preventive surgery and a personalized approach to treatment. They argue that waiting and observing the tumor is no longer sufficient and that early surgery can improve both overall survival and quality of life for patients.<br /><br />The speaker highlights the significance of achieving a maximum resection, as the extent of resection is strongly correlated with survival. They suggest that a supra-total resection should be the first therapeutic option, but emphasize the importance of ensuring safety during the surgery. Intraoperative functional mapping is recommended to reject tissue involved by the tumor based on connectome-based restrictions.<br /><br />The speaker explains that diffuse low-grade gliomas are never stable and that they grow over time, leading to malignant transformation, neurological deficits, and ultimately death. They argue that patients with these tumors often experience cognitive deficits, even if they appear to be well. These deficits are mainly related to the invasion of white matter tracts rather than the tumor's location.<br /><br />The speaker presents data from a study that demonstrates the correlation between tumor volume at diagnosis and survival. They propose performing two MRI scans before treatment to calculate the growth rate of the tumor, as faster-growing tumors have a worse prognosis. They also note that the growth rate is not related to the molecular profile of the tumor.<br /><br />The speaker discusses the importance of functional neuroimaging before surgery to aid in surgical planning. However, they acknowledge the limitations of functional MRI, such as its inability to differentiate between critical and non-critical areas for brain function. They argue for the use of intraoperative electrical stimulation to accurately identify critical structures and preserve brain function.<br /><br />The speaker emphasizes the need for individualized treatment based on multiple parameters, including functional anatomy, patient needs, and social or environmental factors. They advocate for a connectome-based resection approach to minimize tumor volume and avoid malignant transformation while preserving or improving the patient's quality of life.<br /><br />They present examples of successful surgeries in eloquent areas of the brain, emphasizing the role of neuroplasticity in allowing patients to recover and return to normal life. The speaker concludes by highlighting the importance of a preventive and individualized approach to functional oncology, focusing on treating the patient rather than just the tumor.
Keywords
early surgery
maximum safe resection
diffuse low-grade glioma
oncology
preventive surgery
personalized approach
overall survival
quality of life
maximum resection
supra-total resection
intraoperative functional mapping