Ghinda Cristina Diana, Duffau Hugues
Department of Neurosurgery, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Neuroscience Division, University of Ottawa, Ottawa, ON, Canada.
Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France; Brain Plasticity, Stem Cells and Glial Tumors Team, National Institute for Health and Medical Research (INSERM), Montpellier, France.
Front Surg. 2017 Jan 31;4:3. doi: 10.3389/fsurg.2017.00003. eCollection 2017.
Gliomas are the most frequent primary brain tumors and include a variety of different histological tumor types and malignancy grades. Recent achievements in terms of molecular and imaging fields have created an unprecedented opportunity to perform a comprehensive interdisciplinary assessment of the glioma pathophysiology, with direct implications in terms of the medical and surgical treatment strategies available for patients. The current paradigm shift considers glioma management in a comprehensive perspective that takes into account the intricate connectivity of the cerebral networks. This allowed significant improvement in the outcome of patients with lesions previously considered inoperable. The current review summarizes the current theoretical framework integrating the adult human brain plasticity and functional reorganization within a dynamic individualized treatment strategy for patients affected by diffuse low-grade gliomas. The concept of neuro-oncology as a brain network surgery has major implications in terms of the clinical management and ensuing outcomes, as indexed by the increased survival and quality of life of patients managed using such an approach.
神经胶质瘤是最常见的原发性脑肿瘤，包括多种不同的组织学肿瘤类型和恶性程度等级。分子和成像领域的最新进展为全面跨学科评估神经胶质瘤病理生理学创造了前所未有的机会，这对患者可用的医疗和手术治疗策略具有直接影响。当前的范式转变从综合角度考虑神经胶质瘤的管理，该角度考虑了脑网络的复杂连通性。这使得先前被认为无法手术的病变患者的治疗结果有了显著改善。本综述总结了当前的理论框架，该框架将成人大脑可塑性和功能重组整合到弥漫性低级别神经胶质瘤患者的动态个体化治疗策略中。神经肿瘤学作为一种脑网络手术的概念在临床管理和后续结果方面具有重大意义，采用这种方法管理的患者生存率提高和生活质量改善就是证明。
