Object: Recent surgical studies have demonstrated that the extent of resection is significantly correlated with median survival in WHO Grade II gliomas. Consequently, thanks to advances in intraoperative functional mapping, the authors questioned whether it is actually necessary to leave a "security" margin around eloquent structures.
Methods: The authors first reviewed the classic literature, especially that based on epilepsy surgery and functional neuroimaging techniques, which led them to propose the rule of a security margin. Second, they detailed new developments in the field of intrasurgical electrical mapping, especially with regard to subcortical stimulation of the projection and long-distance association pathways. On the basis of these advances, the removal of gliomas according to functional boundaries has recently been suggested, with no margin around eloquent structures.
Results: Comparative results showed that the rate of permanent deficit was similar with or without a security margin, that is, < 2%. However, a higher rate of transient neurological worsening in the immediate postsurgical period was associated with the absence of a margin, with recovery following adapted rehabilitation. On the other hand, the extent of resection was in essence improved with no margin.
Conclusions: This no-margin technique, based on the subpial dissection, and the repetition of both cortical and subcortical stimulation to preserve eloquent cortex as well as the white matter tracts (U-fibers, projection pathways, and long-distance connectivity) allow optimization of the extent of resection while preserving the quality of life (despite transitory impairment) thanks to mechanisms of brain plasticity.
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http://dx.doi.org/10.3171/2009.12.FOCUS09236 | DOI Listing |
Arch Gynecol Obstet
January 2025
Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, China.
Purpose: This case report aims to present a rare case of endometrial carcinosarcoma, a highly malignant tumor with a poor prognosis. The primary objective is to describe this unique case's clinical presentation, multimodal magnetic resonance imaging (MRI) features, typical histopathological characteristics and surgical treatment.
Methods: A detailed analysis of the patient's medical history, preoperative imaging evaluation, and treatment approach was conducted.
Ann Thorac Surg
January 2025
Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Background: The use of local consolidative therapy (LCT) in patients with oligometastatic non-small cell lung cancer (NSCLC) is rapidly evolving, with a preponderance of data supporting the benefits of such therapeutic approaches incorporating pulmonary resection for appropriately selected candidates. However, practices vary widely institutionally and regionally, and evidence-based guidelines are lacking.
Methods: The Society of Thoracic Surgeons assembled a panel of thoracic surgical oncologists to evaluate and synthesize the available evidence regarding the role of pulmonary resection as LCT.
J Clin Med
December 2024
Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan.
Mandibular gingival squamous cell carcinoma (SCC) is the second most common oral cancer after tongue cancer. As these carcinomas often invade the mandible early, accurately defining the resection extent is important. This report highlights the use of preoperative virtual surgery data, computer-aided design and manufacturing (CAD/CAM) technology, surgical guidance, and extended reality (XR) support in achieving highly accurate marginal mandibulectomy without recurrence or metastasis.
View Article and Find Full Text PDFCancers (Basel)
January 2025
Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary.
Glioblastoma, the most common and aggressive primary brain tumor in adults, presents a formidable challenge due to its rapid progression, treatment resistance, and poor survival outcomes. Standard care typically involves maximal safe surgical resection, followed by fractionated external beam radiation therapy and concurrent temozolomide chemotherapy. Despite these interventions, median survival remains approximately 12-15 months, with a five-year survival rate below 10%.
View Article and Find Full Text PDFWorld Neurosurg
January 2025
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA; Department of Otolaryngology, Emory University, Atlanta, Georgia, USA. Electronic address:
Background: Giant pituitary neuroendocrine tumor (GPitNET) are challenging tumors with low rates of gross total resection (GTR) and high morbidity. Previously reported machine-learning (ML) models for prediction of pituitary neuroendocrine tumor extent of resection (EOR) using preoperative imaging included a heterogenous dataset of functional and non-functional pituitary neuroendocrine tumors of various sizes leading to variability in results.
Objective: The aim of this pilot study is to construct a ML model based on the multi-dimensional geometry of tumor to accurately predict the EOR of non-functioning GPitNET.
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