New Techniques for Management of ‘Inoperable’ Gliomas

Cover
New Techniques for
Management of
‘Inoperable’ Gliomas
Copyright
Dedication
Contributors
Preface
	What this book is about?
Introduction to ``inoperable´´ gliomas
	A historical perspective-Tumor surgery and cerebral localization
	Current concepts in glioma surgery
	References
Ethical issues surrounding the operative management of ``inoperable´´ gliomas
	Introduction to the idea of ``inoperability´´
	What does it really mean when we say something is ``inoperable?´´
		Premise 1: If I personally cannot think of an acceptable solution to the present, then as an experienced neurosurgeon one p ...
		Premise 2: We can accurately predict harm vs help in the brain of the patient we are seeing
		Premise 3: The appraisal of out interventions can be simplified to success or failure
		Premise 4: Our views about the relative worth of life in various situations, the willingness to take certain risks, and the ...
	Summary
Novel approaches to brain mapping in the era of functional magnetic resonance imaging
	An introduction to connectomic neuroimaging
	Diffusion tractography
	Functional MRI
	How to utilize these imaging modalities in planning surgery for intrinsic brain tumors
Macroconnectomic networks of the human brain
	Introduction
	The basic organization of the human white matter
		Middle system and the FAT
	Lateral tracts
		Superior longitudinal fasciculus
		Networks inside of the SLF system
			Semantic language
			Auditory network
			Praxis network
			Neglect
			Dorsal attention network
			Ventral attention network
			Executive control network
		Inferior fronto-occipital fasciculus
		Inferior longitudinal fasciculus
		Uncinate fasciculus
		IFOF/ILF/uncinate and the role of the temporal pole in language
	The visual system
		Optic radiations
		Middle longitudinal fasciculus
		Vertical occipital fasciculus
		Occipitotemporal system
		Medial tracts
			Cingulum
		Corpus callosum
			The initiation axis
Surgical techniques and operative nuances of complex glioma surgery
	Introduction
	The basic idea
	The visual appearance of gliomas
		Color
		Consistency
		Response to heat
	The importance of magnification
	Arterial preservation
	How to know when you are done
Advances in the surgical treatment of speech-eloquent gliomas
	Introduction: Language network in glioma patients
	Functional magnetic resonance imaging
	Diffusion tensor imaging
	Electroencephalography and magnetoencephalography
	Transcranial magnetic stimulation
	Direct electrical stimulation
	Additional intraoperative adjuncts: ECoG and intraoperative MRI
	Neuropsychological testing
	Conclusions
	References
Advances in the surgical resection of insular gliomas
	Difficult, but beatable
	Fundamental anatomic relationships of the insula
		Preoperative planning
		Transopercular vs transsylvian approach
		Frontal vs temporal approach
		Intraoperative definition of functional anatomy
	Resecting the tumor
		Phase 1: Exposing the insula
		Phase 2: Removing the insula
		How do you know how deep to go?
		Safety when working in insular windows
Advances in the surgical resection of temporo-parieto-occipital junction gliomas
	Introduction
	Cortical anatomy
	White matter tracts
	Surgical considerations
	Preoperative planning
	Intraoperative techniques
	Conclusion
	References
Surgical management of motor-eloquent gliomas
	Introduction
		Thinking the correct way
		Including considerations of the frontal aslant tract
		Should we try to avoid causing the SMA syndrome in patients with malignant infiltrating gliomas?
	The initiation axis defined
		Safe division cuts of the posteromedial frontal lobe
			The motor system and FAT
			Cuts with the cingulate
		Motor testing
			The basics
			A more nuanced view
	Awake surgery as monitoring
	Tackling the case
		Lower sensorimotor gliomas
			Middle and medial sensorimotor gliomas
Butterfly glioma resection: Surgery around the initiation axis
	Introduction
	The command and control axis defined
	The large-scale functional networks
		Network anatomy
		Default mode network
		Central executive network
		Salience network
		Supplementary motor area
	How to operate around the initiation system
		The fundamental division cuts of the posteromedial frontal lobe
			The motor system and FAT
			Cuts with the cingulate
	How do you test the ``initiation´´ system in surgery?
	Specific techniques and strategies for tumors near the command and control axis
		Medial frontal tumors
	Anterior butterfly gliomas
		Middle callosum butterfly gliomas
		Splenial butterfly gliomas
Thalamic gliomas: Advances in the surgical management
	Introduction
	Preoperative evaluation
		Presentation
		Conventional MRI
		Diffusion tensor tractography
		Other magnetic resonance techniques
	Surgical management
		Intraoperative neurophysiological monitoring
		Intraoperative MRI
		Intraoperative ultrasound
		Surgical approaches
		Minimal retraction systems
		Endoscopic resection of thalamic tumors and gliomas
		Laser therapy and resection
		Guidance catheters
	Conclusion
	References
Essentials to planning a brainstem case
	Introduction
	Clinical presentation and physical examination
	Differential diagnosis on imaging
		Narrowing the differential guides operability
		Diffuse intrinsic pontine glioma
		Identification of focal gliomas
		Separate extraaxial from intraaxial
			Schwannoma
			Meningioma
			Ependymoma
			Subependymoma
			Epidermoid cyst
			Chordoma
			Arachnoid cyst
			Cavernoma
	All brainstem gliomas are not created equal
		Midbrain gliomas
		Pontine gliomas
		Medullary gliomas
	Basic steps to planning the case
		Step 1: Initial considerations
		Step 2: Collect facts
		Step 3: Plan the case
			Applying the keyhole concept to brainstem surgery
			On image guidance
			Diffusion tractography in the brainstem
	Critical insights to evaluation and treatment
		Neurological examination
		Differentiating focal from diffuse glioma on MRI
		Enhancement does not equal malignancy
	Conclusion
	References
	Further reading
Immunotherapy for inoperable gliomas
	Introduction
	Postoperative courses
		Biopsy
		Craniotomy
	Radiotherapy
	Laser interstitial thermal therapy
	Immunotherapy for ``inoperable´´ gliomas
	Principles of glioma immunotherapy
	Cytokine therapies
	Antibody therapies
	Vaccine therapies
	Cellular therapies
	Concluding remarks
	References
Adjuvant therapy and molecular profiling for inoperable gliomas
	Introduction-Inoperable gliomas
	Inoperable gliomas: Surgery around eloquent brain
		Role of surgical resection in the management of gliomas
		Role of biopsy vs resection
	Molecular characterization of gliomas
		New molecular classification scheme for gliomas
		Convergent disruption of cell signaling pathways drive gliomagenesis
		Transcriptionally defined subclasses of GBMs
		Distinct mutational profile of pediatric gliomas
	Treatment of newly diagnosed gliomas
		Current standard of care: Radiation therapy
		Current standard of care: Chemotherapy
	Treatment of recurrent glioma
		Role of backup/salvage chemotherapy for recurrence
		Salvage repeat radiation
		Tumor-treating fields: Novo-TTF-100A
	Emerging modalities for treatment of gliomas
		Gene therapy and genetically engineered virotherapy
		Tumor vaccines and immune checkpoint inhibitors
	Conclusion and future directions
	References
Laser interstitial thermal therapy for ``inoperable´´ gliomas
	Introduction and background of laser interstitial thermal therapy in brain tumors
	Surgical technique
	Radiographic findings
		Patient selection
		Case selection
			LITT for deep primary gliomas
				Case 1
				Case 2
			LITT for recurrent gliomas
				Case 3
				Case 4
			Patient outcomes
	Discussion
	Limitations-Pros/cons
	Conclusion
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	R
	S
	T
	U
	V
	W
	X
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