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Hugues Duffau

performed in all cases during the immediate postoperative period, 3 months postoperatively, and then every 6 months after surgery. The imaging studies allowed an objective evaluation of the extent of glioma removal, according to the classification method reported by Berger et al. 2 Using their criteria resection was classified as total when absolutely no postoperative signal abnormality was detected, subtotal when the volume of residual tumor was < 10 cm 3 , and partial when this volume was ≥ 10 cm 3 . The volume of residual tumor is estimated on T2-weighted or FLAIR MR

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Guilherme Lucas de Oliveira Lima and Hugues Duffau

transformation and thus by significantly increasing survival. 1 , 15 , 20 , 21 , 30 , 46 , 49 Recently the French Glioma Network published the largest surgical series of LGG ever reported, in which multivariate analysis was used to show that extent of resection (EOR) as well as postsurgical residual volume were independent prognostic factors significantly associated with a longer survival—overall survival was approximately 15 years in this series. 5 , 36 As a consequence, according to the current European guidelines, tumor resection represents the first therapeutic option in

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Hugues Duffau and Laurent Capelle

in a more posterior portion of the ACG was noted when bladder volume increased. 3 This activation may reflect a role for the ACG in visceral sensation, that is, the perception of bladder fullness, as demonstrated during esophageal distension. 4 These data could influence the maintenance of continence. Related to this, Blok, et al., 7 reported a cingulate activation detected by PET scanning in a similar location, posterior to the location where deactivation was identified during micturition, in cases of unsuccessful micturition. Our data fit well with these

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Santiago Gil-Robles and Hugues Duffau

of a Security Margin A comparison of results between studies utilizing the margin rule and those not is difficult because of their heterogeneity. Nonetheless, some differences can be pointed out ( Table 1 ). Oncological Considerations We have reported that GIIGs can be considered as ellipsoids, and thus that it is possible to calculate the approximate volume of the tumor by applying the formula 4/3π 3 , that is, the product of the 3 main diameters divided by 2. 43 , 44 We also showed that in our extensive and homogeneous series of GIIGs, the mean lesion

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Fadi Ghareeb and Hugues Duffau

hippocampus, as demonstrated on the preoperative T2-weighted/FLAIR MRI sequences. Imaging Evaluation In the first period of this series, preoperative tumor volume was calculated on the basis of the 3 largest diameters (D1, D2, and D3) of areas of signal abnormality on FLAIR MRI according to the 3 orthogonal planes (axial, sagittal, and coronal). An estimation of tumor volume was calculated by the ellipsoid approximation ([D1 × D2 × D3]/2), as previously reported. 52 Postoperatively, the volume of the residual tumor (if any) was calculated using the same method on the

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Sylvie Moritz-Gasser and Hugues Duffau

in the residual glioma volume was seen on repeat MR imaging, with enhancement located around the posterior part of the superior temporal sulcus ( Fig. 1A ). Moreover, the patient experienced new seizures. At that time, he was referred to our institution for a second surgery. F ig . 1. A: Preoperative axial (left) and sagittal (right) enhanced T1-weighted MR images showing a posterior left temporal glioma. B: Intraoperative photograph showing eloquent sites eliciting language disturbances during stimulation as follows: 9, corresponding to the speech

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Eduardo Santamaria Carvalhal Ribas and Hugues Duffau

or taste disorders. Because of the volume of the tumor (45 ml), resection was proposed. F ig . 1. A: Preoperative axial FLAIR MR images showing a hypersignal involving the left temporoinsular structures. B: Intraoperative photograph obtained before resection (left) , showing letter tags that indicate tumor boundaries. Stimulation over the rolandic operculum induced speech arrest (1, precentral part; 2, postcentral part), and stimulation over the posterior portion of the superior temporal gyrus induced anomia (10). Intraoperative photograph obtained

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Gaëtan Poulen, Catherine Gozé, Valérie Rigau and Hugues Duffau

surgically treated between 2007 and 2013 for histopathologically confirmed supratentorial, IDH-wt, non–1p19q-codeleted AII. All patients had a minimum follow-up of 2 years. Clinical characteristics (age, sex, neurological status), radiological features (topography, tumor volume, velocity of diameter expansion), surgical results (extent of resection, delay before administering adjuvant oncological therapy), and survival were collected and analyzed. Radiological Examination The topography of each tumor was accurately analyzed using preoperative 3D MR images (T1-weighted and

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Yordanka N. Yordanova, Sylvie Moritz-Gasser and Hugues Duffau

parietal gyri), basal ganglia, internal capsule, thalamus, and visual cortex around the calcarine sulcus. 3 The presumed noneloquent areas were defined as all brain structures not belonging to the regions mentioned above. They were therefore determined on the basis of preoperative anatomical MR imaging. Evaluation Methods Information concerning the following parameters was obtained for all patients: sex, age at diagnosis, first symptom, tumor location, preoperative tumor volume and surgically resected volume (evaluated on pre- and postoperative MR imaging

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Gaëtan Poulen, Catherine Gozé, Valérie Rigau and Hugues Duffau

surgically treated between 2007 and 2013 for histopathologically confirmed supratentorial, IDH-wt, non–1p19q-codeleted AII. All patients had a minimum follow-up of 2 years. Clinical characteristics (age, sex, neurological status), radiological features (topography, tumor volume, velocity of diameter expansion), surgical results (extent of resection, delay before administering adjuvant oncological therapy), and survival were collected and analyzed. Radiological Examination The topography of each tumor was accurately analyzed using preoperative 3D MR images (T1-weighted and