AUTHOR=Giammalva Giuseppe Roberto , Brunasso Lara , Costanzo Roberta , Paolini Federica , Umana Giuseppe Emmanuele , Scalia Gianluca , Gagliardo Cesare , Gerardi Rosa Maria , Basile Luigi , Graziano Francesca , Gulì Carlo , Messina Domenico , Pino Maria Angela , Feraco Paola , Tumbiolo Silvana , Midiri Massimo , Iacopino Domenico Gerardo , Maugeri Rosario TITLE=Brain Mapping-Aided SupraTotal Resection (SpTR) of Brain Tumors: The Role of Brain Connectivity JOURNAL=Frontiers in Oncology VOLUME=11 YEAR=2021 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.645854 DOI=10.3389/fonc.2021.645854 ISSN=2234-943X ABSTRACT=

Brain gliomas require a deep knowledge of their effects on brain connectivity. Understanding the complex relationship between tumor and functional brain is the preliminary and fundamental step for the subsequent surgery. The extent of resection (EOR) is an independent variable of surgical effectiveness and it correlates with the overall survival. Until now, great efforts have been made to achieve gross total resection (GTR) as the standard of care of brain tumor patients. However, high and low-grade gliomas have an infiltrative behavior and peritumoral white matter is often infiltrated by tumoral cells. According to these evidences, many efforts have been made to push the boundary of the resection beyond the contrast-enhanced lesion core on T1w MRI, in the so called supratotal resection (SpTR). SpTR is aimed to maximize the extent of resection and thus the overall survival. SpTR of primary brain tumors is a feasible technique and its safety is improved by intraoperative neuromonitoring and advanced neuroimaging. Only transient cognitive impairments have been reported in SpTR patients compared to GTR patients. Moreover, SpTR is related to a longer overall and progression-free survival along with preserving neuro-cognitive functions and quality of life.