{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:20:26Z","timestamp":1792052426844,"version":"4.4.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Surgery for giant diffuse lower-grade gliomas (LGGs) is challenging, and very few data have been reported on this topic in the literature. In this article, the authors investigated surgical, functional, and oncological aspects in patients who underwent awake resection for large LGGs with a volume &gt; 100 cm<jats:sup>3<\/jats:sup>.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively reviewed a consecutive cohort of patients who underwent surgery in an awake condition for an LGG (WHO grade 2 with possible foci of grade 3 transformation) with a volume &gt; 100 cm<jats:sup>3<\/jats:sup>.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 108 patients were included, with a mean age of 36.1 \u00b1 8.5 years. The mean presurgical LGG volume was 136.7 \u00b1 34.5 cm<jats:sup>3<\/jats:sup>. In all but 2 patients a disconnection resective surgery up to functional boundaries was possible thanks to active patient collaboration during the awake period. At 3 months of follow-up, all but 1 patient had a normal neurological examination, with a mean Karnofsky Performance Status (KPS) score of 89.8 \u00b1 10.36. In all patients with preoperative epilepsy, there was postoperative control or significant reduction of seizure events. Moreover, 85.1% of patients returned to work. The mean extent of resection (EOR) was 88.9% \u00b1 7.0%, with a mean residual tumor volume (RTV) of 16.3 \u00b1 12.0 cm<jats:sup>3<\/jats:sup> (median RTV 15 cm<jats:sup>3<\/jats:sup>). Pathological examination revealed 73 grade 2 gliomas (67.6%; 26 oligodendrogliomas and 47 astrocytomas) and 35 gliomas with foci of grade 3 (32.4%; 19 oligodendrogliomas and 16 astrocytomas). During the postoperative period, 93.6% of patients underwent adjuvant chemotherapy with a median interval between surgery and first chemotherapy of 14 months (IQR 2\u201326 months), and 55% of patients had radiotherapy with a median interval of 38.5 months (IQR 18\u201359.8 months). At the last follow-up, 69.7% of patients were still alive with a median follow-up of 62 months (IQR 36\u201399 months). Overall survival (OS) rates at 1, 5, and 10 years were 100% (95% CI 0.99\u20131), 80% (95% CI 0.72\u20130.9), and 58% (95% CI 0.45\u20130.73), respectively. The median OS was 138 months. In multivariable Cox regression analysis, RTV was established as the only independent prognostic factor for survival.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>With the application of rigorous surgical methodology based on functional-guided resection, resection of giant LGGs (volume &gt; 100 cm<jats:sup>3<\/jats:sup>) can be reproducibly achieved during surgery with patients under awake mapping with both favorable functional results (&lt; 1% permanent neurological worsening) and favorable long-term oncological outcomes (median OS &gt; 11 years, with a more significant benefit when the RTV is &lt; 15 cm<jats:sup>3<\/jats:sup>).<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.2.jns222755","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T16:44:05Z","timestamp":1679676245000},"page":"934-943","source":"Crossref","is-referenced-by-count":11,"title":["Surgical, functional, and oncological considerations regarding awake resection for giant diffuse lower-grade glioma of more than 100 cm3"],"prefix":"10.3171","volume":"139","author":[{"given":"Sidonie","family":"Sauvageot","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Boetto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and"},{"name":"Institute of Functional Genomics (IFG), University of Montpellier, INSERM U1191, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Duffau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and"},{"name":"Institute of Functional Genomics (IFG), University of Montpellier, INSERM U1191, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"26","key":"b1","series-title":"N Engl J Med","first-page":"2481","article-title":"Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas","volume":"372","author":"Brat DJ","year":"2015","unstructured":"Brat DJ, Verhaak RG, Aldape KD,  Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas. N Engl J Med. 2015;372(26):2481\u20132498."},{"key":"b2","series-title":"Diffuse Low-Grade Gliomas in Adults","year":"2017","unstructured":"Duffau H, ed. Diffuse Low-Grade Gliomas in Adults. 2nd ed. Springer International Publishing; 2017."},{"issue":"6","key":"b3","series-title":"J Neurosurg","first-page":"1157","article-title":"Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases: clinical article","volume":"118","author":"Capelle L","year":"2013","unstructured":"Capelle L, Fontaine D, Mandonnet E,  Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases: clinical article. J Neurosurg. 2013;118(6):1157\u20131168."},{"issue":"1","key":"b4","series-title":"J Neurosurg","first-page":"10","article-title":"Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas","volume":"112","author":"Chaichana KL","year":"2010","unstructured":"Chaichana KL, McGirt MJ, Laterra J, Olivi A, Qui\u00f1ones-Hinojosa A. Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas. J Neurosurg. 2010;112(1):10\u201317."},{"issue":"1","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"51","article-title":"Long-term outcomes after supratotal resection of diffuse low-grade gliomas: a consecutive series with 11-year follow-up","volume":"158","author":"Duffau H","year":"2016","unstructured":"Duffau H. Long-term outcomes after supratotal resection of diffuse low-grade gliomas: a consecutive series with 11-year follow-up. Acta Neurochir (Wien). 2016;158(1):51\u201358."},{"issue":"6","key":"b6","series-title":"J Neurosurg","first-page":"1692","article-title":"Is supratotal resection achievable in low-grade gliomas? Feasibility, putative factors, safety, and functional outcome","volume":"132","author":"Rossi M","year":"2019","unstructured":"Rossi M, Ambrogi F, Gay L,  Is supratotal resection achievable in low-grade gliomas? Feasibility, putative factors, safety, and functional outcome. J Neurosurg. 2019;132(6):1692\u20131705."},{"issue":"8","key":"b7","series-title":"Ann Oncol","first-page":"1942","article-title":"Surgical resection versus watchful waiting in low-grade gliomas","volume":"28","author":"Jakola AS","year":"2017","unstructured":"Jakola AS, Skjulsvik AJ, Myrmel KS,  Surgical resection versus watchful waiting in low-grade gliomas. Ann Oncol. 2017;28(8):1942\u20131948."},{"key":"b8","series-title":"Sci Rep","first-page":"32286","article-title":"Residual tumor volume as best outcome predictor in low grade glioma\u2014a nine-years near-randomized survey of surgery vs. biopsy","volume":"6","author":"Roelz R","year":"2016","unstructured":"Roelz R, Strohmaier D, Jabbarli R,  Residual tumor volume as best outcome predictor in low grade glioma\u2014a nine-years near-randomized survey of surgery vs. biopsy. Sci Rep. 2016;6:32286."},{"issue":"1","key":"b9","series-title":"Neuroimage","first-page":"369","article-title":"Motor and language DTI fiber tracking combined with intraoperative subcortical mapping for surgical removal of gliomas","volume":"39","author":"Bello L","year":"2008","unstructured":"Bello L, Gambini A, Castellano A,  Motor and language DTI fiber tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. Neuroimage. 2008;39(1):369\u2013382."},{"issue":"5","key":"b10","series-title":"Neuro Oncol","first-page":"781","article-title":"Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: a longitudinal, within-patient design study","volume":"24","author":"Lemaitre AL","year":"2022","unstructured":"Lemaitre AL, Herbet G, Ng S, Moritz-Gasser S, Duffau H. Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: a longitudinal, within-patient design study. Neuro Oncol. 2022;24(5):781\u2013793."},{"issue":"3","key":"b11","series-title":"Clinical article. J Neurosurg","first-page":"566","article-title":"Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival","volume":"114","author":"Chang EF","year":"2011","unstructured":"Chang EF, Clark A, Smith JS,  Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article. J Neurosurg. 2011;114(3):566\u2013573."},{"issue":"6","key":"b12","series-title":"J Neurosurg","first-page":"1039","article-title":"Low-grade glioma surgery in eloquent areas: volumetric analysis of extent of resection and its impact on overall survival. A single-institution experience in 190 patients: clinical article","volume":"117","author":"Ius T","year":"2012","unstructured":"Ius T, Isola M, Budai R,  Low-grade glioma surgery in eloquent areas: volumetric analysis of extent of resection and its impact on overall survival. A single-institution experience in 190 patients: clinical article. J Neurosurg. 2012;117(6):1039\u20131052."},{"issue":"2","key":"b13","series-title":"J Neurosurg","first-page":"480","article-title":"Surgical management of incidentally discovered low-grade gliomas","volume":"135","author":"Gogos AJ","year":"2021","unstructured":"Gogos AJ, Young JS, Pereira MP,  Surgical management of incidentally discovered low-grade gliomas. J Neurosurg. 2021;135(2):480\u2013487."},{"issue":"1","key":"b14","series-title":"J Neurooncol","first-page":"65","article-title":"Comparative volumetric analysis of the extent of resection of molecularly and histologically distinct low grade gliomas and its role on survival","volume":"134","author":"Eseonu CI","year":"2017","unstructured":"Eseonu CI, Eguia F, ReFaey K,  Comparative volumetric analysis of the extent of resection of molecularly and histologically distinct low grade gliomas and its role on survival. J Neurooncol. 2017;134(1):65\u201374."},{"issue":"1","key":"b15","series-title":"Sci Rep","first-page":"9964","article-title":"Multimodal integrated approaches in low grade glioma surgery","volume":"11","author":"Ius T","year":"2021","unstructured":"Ius T, Mazzucchi E, Tomasino B,  Multimodal integrated approaches in low grade glioma surgery. Sci Rep. 2021;11(1):9964."},{"issue":"5","key":"b16","series-title":"J Neurol","first-page":"2627","article-title":"The persistence of seizures after tumor resection negatively affects survival in low-grade glioma patients: a clinical retrospective study","volume":"269","author":"Mazzucchi E","year":"2022","unstructured":"Mazzucchi E, Vollono C, Pauletto G,  The persistence of seizures after tumor resection negatively affects survival in low-grade glioma patients: a clinical retrospective study. J Neurol. 2022;269(5):2627\u20132633."},{"key":"b17","series-title":"Front Oncol","first-page":"851803","article-title":"Early surgery prolongs professional activity in IDH mutant low-grade glioma patients: a policy change analysis","volume":"12","author":"Robe PA","year":"2022","unstructured":"Robe PA, Rados M, Spliet WG,  Early surgery prolongs professional activity in IDH mutant low-grade glioma patients: a policy change analysis. 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Front Oncol. 2021;11:629166."},{"issue":"5","key":"b19","series-title":"J Neurosurg","first-page":"1291","article-title":"Contemporary assessment of extent of resection in molecularly defined categories of diffuse low-grade glioma: a volumetric analysis","volume":"133","author":"Kavouridis VK","year":"2020","unstructured":"Kavouridis VK, Boaro A, Dorr J,  Contemporary assessment of extent of resection in molecularly defined categories of diffuse low-grade glioma: a volumetric analysis. J Neurosurg. 2020;133(5):1291\u20131301."},{"issue":"8","key":"b20","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: a summary","volume":"23","author":"Louis DN","year":"2021","unstructured":"Louis DN, Perry A, Wesseling P,  The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231\u20131251."},{"issue":"6","key":"b21","series-title":"J Neurosurg","first-page":"1380","article-title":"Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks","volume":"119","author":"Fern\u00e1ndez Coello A","year":"2013","unstructured":"Fern\u00e1ndez Coello A, Moritz-Gasser S, Martino J, Martinoni M, Matsuda R, Duffau H. Selection of intraoperative tasks for awake mapping based on relationships between tumor location and functional networks. J Neurosurg. 2013;119(6):1380\u20131394."},{"key":"b22","series-title":"Front Oncol","first-page":"924762","article-title":"Constant multi-tasking with time constraint to preserve across-network dynamics throughout awake surgery for low-grade glioma: a necessary step to enable patients resuming an active life","volume":"12","author":"Duffau H","year":"2022","unstructured":"Duffau H, Ng S, Lemaitre AL, Moritz-Gasser S, Herbet G. 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Acta Neurochir (Wien). 2021;163(4):905\u2013917."},{"issue":"1","key":"b24","series-title":"Neurosurgery","first-page":"182","article-title":"Awake mapping with transopercular approach in right insular-centered low-grade gliomas improves neurological outcomes and return to work","volume":"91","author":"Duffau H","year":"2022","unstructured":"Duffau H. Awake mapping with transopercular approach in right insular-centered low-grade gliomas improves neurological outcomes and return to work. Neurosurgery. 2022;91(1):182\u2013190."},{"key":"b25","series-title":"Neuroimage","first-page":"116237","article-title":"Mapping critical cortical hubs and white matter pathways by direct electrical stimulation: an original functional atlas of the human brain","volume":"205","author":"Sarubbo S","year":"2020","unstructured":"Sarubbo S, Tate M, De Benedictis A,  Mapping critical cortical hubs and white matter pathways by direct electrical stimulation: an original functional atlas of the human brain. Neuroimage. 2020;205:116237."},{"issue":"11","key":"b26","series-title":"Acta Neurochir (Wien)","first-page":"3115","article-title":"Language recovery through a two-stage awake surgery in an aphasic patient with a voluminous left fronto-temporo-insular glioma: case report","volume":"163","author":"Louppe E","year":"2021","unstructured":"Louppe E, Moritz-Gasser S, Duffau H. Language recovery through a two-stage awake surgery in an aphasic patient with a voluminous left fronto-temporo-insular glioma: case report. Acta Neurochir (Wien). 2021;163(11):3115\u20133119."},{"key":"b27","series-title":"Cortex","first-page":"325","article-title":"The huge plastic potential of adult brain and the role of connectomics: new insights provided by serial mappings in glioma surgery","volume":"58","author":"Duffau H","year":"2014","unstructured":"Duffau H. The huge plastic potential of adult brain and the role of connectomics: new insights provided by serial mappings in glioma surgery. Cortex. 2014;58:325\u2013337."},{"issue":"4","key":"b28","series-title":"Acta Neurochir (Wien)","first-page":"569","article-title":"The challenge to remove diffuse low-grade gliomas while preserving brain functions","volume":"154","author":"Duffau H","year":"2012","unstructured":"Duffau H. The challenge to remove diffuse low-grade gliomas while preserving brain functions. Acta Neurochir (Wien). 2012;154(4):569\u2013574."},{"issue":"Pt 4","key":"b29","series-title":"Brain","first-page":"898","article-title":"Contrasting acute and slow-growing lesions: a new door to brain plasticity","volume":"130","author":"Desmurget M","year":"2007","unstructured":"Desmurget M, Bonnetblanc F, Duffau H. Contrasting acute and slow-growing lesions: a new door to brain plasticity. Brain. 2007;130(Pt 4):898-914."},{"issue":"Pt 2","key":"b30","series-title":"Brain","first-page":"449","article-title":"Epileptic seizures in diffuse low-grade gliomas in adults","volume":"137","author":"Pallud J","year":"2014","unstructured":"Pallud J, Audureau E, Blonski M,  Epileptic seizures in diffuse low-grade gliomas in adults. Brain. 2014;137(Pt 2):449-462."},{"issue":"6","key":"b31","series-title":"Acta Neurochir (Wien)","first-page":"563","article-title":"Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy","volume":"144","author":"Duffau H","year":"2002","unstructured":"Duffau H, Capelle L, Lopes M, Bitar A, Sichez JP, van Effenterre R. Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy. Acta Neurochir (Wien). 2002;144(6):563\u2013573."},{"issue":"10","key":"b32","series-title":"Acta Neurochir (Wien)","first-page":"2789","article-title":"The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review","volume":"164","author":"Pascual JSG","year":"2022","unstructured":"Pascual JSG, Duffau H. The need to consider return to work as a main outcome in patients undergoing surgery for diffuse low-grade glioma: a systematic review. Acta Neurochir (Wien). 2022;164(10):2789\u20132809."},{"issue":"14","key":"b33","series-title":"N Engl J Med","first-page":"1344","article-title":"Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma","volume":"374","author":"Buckner JC","year":"2016","unstructured":"Buckner JC, Shaw EG, Pugh SL,  Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med. 2016;374(14):1344\u20131355."},{"issue":"4","key":"b34","series-title":"Neurooncol Pract","first-page":"264","article-title":"Chemotherapy and diffuse low-grade gliomas: a survey within the European Low-Grade Glioma Network","volume":"6","author":"Darlix A","year":"2019","unstructured":"Darlix A, Mandonnet E, Freyschlag CF,  Chemotherapy and diffuse low-grade gliomas: a survey within the European Low-Grade Glioma Network. Neurooncol Pract. 2019;6(4):264\u2013273."},{"issue":"4","key":"b35","series-title":"Acta Neuropathol","first-page":"601","article-title":"The DNA methylome of DDR genes and benefit from RT or TMZ in IDH mutant low-grade glioma treated in EORTC 22033","volume":"135","author":"Bady P","year":"2018","unstructured":"Bady P, Kurscheid S, Delorenzi M,  The DNA methylome of DDR genes and benefit from RT or TMZ in IDH mutant low-grade glioma treated in EORTC 22033. Acta Neuropathol. 2018;135(4):601\u2013615."},{"key":"b36","series-title":"Front Oncol","first-page":"574679","article-title":"Adult diffuse low-grade gliomas: 35-year experience at the Nancy France Neurooncology Unit","volume":"10","author":"Obara T","year":"2020","unstructured":"Obara T, Blonski M, Brzenczek C,  Adult diffuse low-grade gliomas: 35-year experience at the Nancy France Neurooncology Unit. Front Oncol. 2020;10:574679."},{"issue":"1","key":"b37","series-title":"J Neurosurg","first-page":"1","article-title":"Insular glioma resection: assessment of patient morbidity, survival, and tumor progression","volume":"112","author":"Sanai N","year":"2010","unstructured":"Sanai N, Polley MY, Berger MS. Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg. 2010;112(1):1\u20139."},{"issue":"3","key":"b38","series-title":"J Neurosurg","first-page":"706","article-title":"Transcortical insular glioma resection: clinical outcome and predictors","volume":"131","author":"Hameed NUF","year":"2018","unstructured":"Hameed NUF, Qiu T, Zhuang D,  Transcortical insular glioma resection: clinical outcome and predictors. 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