Duffau Hugues
Department of Neurosurgery, INSERM U678, Hôpital Salpêtrière, Paris, France.
Lancet Neurol. 2005 Aug;4(8):476-86. doi: 10.1016/S1474-4422(05)70140-X.
Surgical treatment of low-grade gliomas (LGGs) aims to maximise the amount of tumour tissue resected, while minimising the risk of functional sequelae. In this review I address the issue of how to reconcile these two conflicting goals. First, I review the natural history of LGG-growth, invasion, and anaplastic transformation. Second, I discuss the contribution of new techniques, such as functional mapping, to our understanding of brain reorganisation in response to progressive growth of LGG. Third, I consider the clinical implications of interactions between tumour progression and brain plasticity. In particular, I show how longitudinal studies (preoperative, intraoperative, and postoperative) could allow us to optimise the surgical risk-to-benefit ratios. I will also discuss controversial issues such as defining surgical indications for LGGs, predicting the risk of postoperative deficit, aspects of operative surgical neuro-oncology (eg, preoperative planning and preservation of functional areas and tracts), and postoperative functional recovery.
低级别胶质瘤（LGGs）的外科治疗旨在最大限度地切除肿瘤组织，同时将功能后遗症的风险降至最低。在这篇综述中，我探讨了如何协调这两个相互冲突的目标这一问题。首先，我回顾了LGG的自然病史——生长、侵袭和间变转化。其次，我讨论了诸如功能图谱等新技术对我们理解LGG渐进性生长所引发的脑重组的贡献。第三，我考虑了肿瘤进展与脑可塑性之间相互作用的临床意义。特别是，我展示了纵向研究（术前、术中和术后）如何使我们能够优化手术的风险效益比。我还将讨论一些有争议的问题，如LGG的手术指征定义、术后缺损风险预测、手术神经肿瘤学的各个方面（例如术前规划以及功能区和神经束的保留）以及术后功能恢复。
