![]() The goal was to detect elements that could aid in the prediction of functional outcome and extent of resection in eloquent area tumors. In the current work, we attempted to collect radiological, clinical, and surgical datasets of patients with gliomas in intraoperatively confirmed eloquent areas. Understandably, the majority of the studies of glioma surgery outcomes had the goal of assessing prognostic factors related primarily to survival and/or tumor progression –. Unfortunately, it is not clear which pre-, intra-, and postoperative parameters can aid in preoperatively predicting the EOR or the risk of postoperative exacerbation thus, it is difficult to define patient subgroups. For surgical treatment of both HGG and LGG, it is largely recognized that preoperative and intraoperative brain mapping are crucial for maximizing resection while minimizing morbidity –. The increasing use of preoperative and intraoperative brain mapping techniques has radically changed the classical concept of standardized eloquent areas thus, shifting towards a more individualized approach. Conversely, LGG patients survive longer and are younger therefore, a permanent deficit will be more difficult to accept because surgery cannot heal this disease. Some authors have demonstrated that postoperative low performance status can often impede the administration of adjuvant treatments thus, resulting in decreased survival. In fact, for HGGs, the short life expectancy and the routine use of adjuvant treatments require a good postoperative performance status because the time in which recovery can occur is short and the treatments can potentially exacerbate deterioration. Studies that stress the necessity of achieving a wider larger resection have prompted a discussion regarding the importance of maintaining an adequate postoperative functional status as a goal both in LLGs and HGGs, particularly in “eloquent areas tumors” (EATs). More recently, robust evidence has supported the importance of gross total resection for the prognosis of low-grade gliomas (LGGs) –. For high-grade gliomas, the extent of resection (EOR) is a largely accepted parameter that significantly influence the prognosis both in terms of overall survival and progression free survival –. Median survival times have been reported to range between 5 and 10 years, and estimates of 10-year survival rates range from 5–50% –. Despite facing a better prognosis when compared with higher grade glial tumors, 50–75% of patients harboring low-grade gliomas eventually die of their disease. These lesions are extremely aggressive, and the vast majority of patients invariably suffer tumor recurrence, with the median survival time ranging from 1 to 3 years after initial diagnosis. Supratentorial gliomas are a heterogeneous group of brain tumors accounting for approximately 30% of all adult primary intracranial tumors and more than half of these are high-grade gliomas (HGGs).
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