Clinical Scorecard: Intraoperative Brain Mapping Techniques for Glioma Resection: An In-Depth Analysis of the UCSF Protocol

At a Glance

Key Highlights

• Maximal resection of contrast-enhancing and FLAIR borders is the gold standard for glioma treatment.

• Intraoperative mapping is associated with fewer neurological deficits and higher rates of maximal resection.

• Awake and asleep mapping techniques are utilized to enhance patient safety and comfort.

• Preoperative imaging with DTI and MEG is critical for surgical planning.

• The onco-functional outcome (OFO) classification scheme helps assess resection outcomes.

Guideline-Based Recommendations

Diagnosis

• Utilize MRI with and without gadolinium, DTI, and MEG for preoperative assessment.

Management

• Perform maximal resection while preserving functional status.

Monitoring & Follow-up

• Assess neurological function postoperatively to evaluate for deficits.

Risks

• Increased risk of neurological deficits with larger resections, especially near functional cortex.

Patient & Prescribing Data

Adults with diffuse gliomas, particularly those with IDH mutant astrocytomas and oligodendrogliomas.

Supratotal resection beyond FLAIR margins is associated with lower recurrence risk and improved survival.

Clinical Best Practices

• Implement intraoperative motor and language mapping to minimize neurological deficits.

• Utilize asleep conditions for motor mapping to enhance accuracy and patient comfort.

• Incorporate DTI and MEG in preoperative planning to improve surgical outcomes.

Related Resources & Content

1. Gerritsen et al., Neuro-Oncology, 2023 -- Intraoperative Brain Mapping Techniques for Glioma Resection

2. Awake Tumor Resection Utilizing Direct Electrical Stimulation Mapping and Real-Time Cognitive Assessment: Our Approach

3. An Innovative Neurosurgical Technique for Extensive Resection of Non-Dominant Precuneal Gliomas: A Case Study

4. Utilizing Indirect Cognitive Mapping Techniques in Glioma Surgery for Patients Ineligible for Awake Craniotomy – My Approach

5. Preoperative nTMS Evaluation: An Effective Method for Identifying Potential Motor Impairments in Patients with Brain Tumors

6. Awake Tumor Resection Utilizing Direct Electrical Stimulation Mapping and Real-Time Cognitive Assessment: Our Approach

7. An Innovative Neurosurgical Technique for Extensive Resection of Non-Dominant Precuneal Gliomas: A Case Study

8. Utilizing Indirect Cognitive Mapping Techniques in Glioma Surgery for Patients Ineligible for Awake Craniotomy – My Approach

9. EANS-EANO guidelines on the extent of resection in gliomas

10. Impact of awake mapping on extent of resection and neurological outcomes of Low-grade gliomas: a systematic review and Meta-analysis - PubMed

11. A comprehensive framework for glioma surgery by the PIONEER Consortium and RANO resect group, part 1: intraoperative recommendations for mapping, monitoring, and decision making - PubMed