{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:50:11Z","timestamp":1791399011701,"version":"4.3.3"},"reference-count":41,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,8]]},"abstract":"\nObject<\/jats:title>\nIt has been demonstrated that an extensive resection (total or subtotal) may significantly increase the overall survival in patients with WHO Grade II gliomas (low-grade gliomas [LGGs]). Yet, recent data have shown that conventional MR imaging underestimates the spatial extent of LGG, since tumor cells were found up to 20 mm around MR imaging abnormalities. Thus, it was hypothesized that an extended resection with a margin beyond MR imaging\u2013defined abnormalities\u2014a \u201csupratotal\u201d resection\u2014might improve the outcome of LGG. However, because of the frequent location of LGG within \u201celoquent\u201d brain areas, it is often difficult to achieve such a supratotal resection. This could nevertheless be possible when LGGs involve \u201cnoneloquent\u201d areas, even in the left dominant hemisphere. The authors report on their use of awake electrical mapping to tailor the resection according to functional boundaries, that is, to pursue the resection beyond MR imaging\u2013defined abnormalities, until corticosubcortical eloquent structures are encountered. Their aim was to apply this reliable surgical technique to LGGs located not within eloquent areas but distant from eloquent areas, to take a margin around the LGG visible on MR imaging while preserving brain function.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nFifteen right-handed patients with a total of 17 tumors underwent resection of WHO Grade II gliomas involving nonfunctional areas within the left dominant hemisphere. In all patients, seizures were the initial manifestation of the tumors. Awake surgery with intraoperative electrostimulation was performed in all cases. The resection was continued until the surgeon reached cortical and subcortical areas crucial for brain function, especially language, as defined by the intrasurgical electrical mapping. The extent of resection was evaluated on postoperative FLAIR-weighted MR images.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nDespite transient neurological worsening in 60% of cases, all patients recovered and returned to a normal life. Seizure control was obtained in all patients with a decrease of antiepileptic drug therapy. Postoperative MR imaging showed that total resection was achieved in all 17 tumors and supratotal resection in 15. The average volume of the postoperative cavity (36.8 cm3<\/jats:sup>) was significantly larger than the mean preoperative tumor volume (26.6 cm3<\/jats:sup>) (p = 0.009). Neuropathological examination confirmed the diagnosis of WHO Grade II glioma in all cases. The mean duration of postoperative follow-up was 35.7 months (range 6\u2013135 months). Only 4 of 15 patients experienced recurrence (without anaplastic transformation); the average time to recurrence in these cases was 38 months; radiotherapy was performed 6 years after the relapse in 1 case; no other patients received any adjuvant treatment. This series was compared with a control group of 29 patients who had \u201conly\u201d complete resection: anaplastic transformation was observed in 7 cases in the control group but not in any case in the series of patients who underwent supracomplete resection (p = 0.037). Furthermore, adjuvant treatment was administered in 10 patients in the control group compared with 1 patient who underwent supracomplete resection (p = 0.043).<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThese findings support the usefulness of awake surgery with intraoperative functional (language) mapping with the attempt to perform supratotal resection of LGGs involving noneloquent areas in the left hemisphere. Indeed, the extent of resection was significantly increased in all cases but 2, with no additional permanent deficit and with control of seizures in all patients. The goal of supracomplete resection is currently to delay the anaplastic transformation, even if it does not (yet) enable a cure.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.3.jns101333","type":"journal-article","created":{"date-parts":[[2011,5,6]],"date-time":"2011-05-06T14:28:09Z","timestamp":1304692089000},"page":"232-239","source":"Crossref","is-referenced-by-count":313,"title":["Awake surgery for WHO Grade II gliomas within \u201cnoneloquent\u201d areas in the left dominant hemisphere: toward a \u201csupratotal\u201d resection"],"prefix":"10.3171","volume":"115","author":[{"given":"Yordanka N.","family":"Yordanova","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, H\u00f4pital Gui de Chauliac, CHU Montpellier;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Moritz-Gasser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, H\u00f4pital Gui de Chauliac, CHU Montpellier;"},{"name":"Team \u201cPlasticity of Central Nervous System, Stem Cells and Glial Tumors,\u201d INSERM U1051, Institut of Neurosciences of Montpellier, H\u00f4pital Saint Eloi, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Duffau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, H\u00f4pital Gui de Chauliac, CHU Montpellier;"},{"name":"Team \u201cPlasticity of Central Nervous System, Stem Cells and Glial Tumors,\u201d INSERM U1051, Institut of Neurosciences of Montpellier, H\u00f4pital Saint Eloi, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns101333","series-title":"Acta Neurochir (Wien)","first-page":"1359","article-title":"Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients","volume":"151","author":"Ahmadi","year":"2009"},{"key":"b2-jns101333","series-title":"Cancer","first-page":"1784","article-title":"The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas","volume":"74","author":"Berger","year":"1994"},{"key":"b3-jns101333","series-title":"J Neurosurg","first-page":"817","article-title":"Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. 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An electrical stimulation mapping investigation in 117 patients","volume":"71","author":"Ojemann","year":"1989"},{"key":"b27-jns101333","series-title":"Neuropsychologia","first-page":"97","article-title":"The assessment and analysis of handedness: the Edinburgh inventory","volume":"9","author":"Oldfield","year":"1971"},{"key":"b28-jns101333","series-title":"J Neurooncol","first-page":"239","article-title":"Glioma dissemination along the corticospinal tract","volume":"73","author":"Pallud","year":"2005"},{"key":"b29-jns101333","series-title":"Neurology","first-page":"1724","article-title":"Diffuse low-grade oligodendrogliomas extend beyond MRI-defined abnormalities","volume":"74","author":"Pallud","year":"2010"},{"key":"b30-jns101333","series-title":"J Neurooncol","first-page":"253","article-title":"Current concepts in the evaluation and management of WHO grade II gliomas","volume":"92","author":"Piepmeier","year":"2009"},{"issue":"2","key":"b31-jns101333","series-title":"Neurosurg Focus","first-page":"E3","article-title":"The reliability of neuroanatomy as a predictor of eloquence: a review","volume":"28","author":"Pouratian","year":"2010"},{"key":"b32-jns101333","series-title":"Eur J Radiol","first-page":"54","article-title":"Volumes and growth rates of untreated adult low-grade gliomas indicate risk of early malignant transformation","volume":"72","author":"Rees","year":"2009"},{"key":"b33-jns101333","series-title":"Neurosurgery","first-page":"753","article-title":"Glioma extent of resection and its impact on patient outcome","volume":"62","author":"Sanai","year":"2008"},{"key":"b34-jns101333","series-title":"N Engl J Med","first-page":"18","article-title":"Functional outcome after language mapping for glioma resection","volume":"358","author":"Sanai","year":"2008"},{"key":"b35-jns101333","series-title":"J Neurosurg","first-page":"835","article-title":"Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. 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