Gliomas are primitive brain tumors arising from glial cells, which play an essential supporting role for neurons.
How do they manifest themselves?
These tumors are discovered either during an epileptic seizure, or when neurological deficits (motor, language, behavioral or visual disorders, etc.) or headaches (increased intracranial pressure) develop.
There are four grades of increasing aggressiveness. Grade I tumors can be completely removed, and thus cured by surgery. Grade II, III and IV tumors are diffuse: some tumor cells are isolated within normal, functional brain tissue, and cannot be completely removed. Further treatment will be required either immediately after surgery, or in the event of recurrence. For grade II tumors, this usually involves re-operation or chemotherapy, followed by radiotherapy at a later stage. For grade III and IV tumors, treatment involves a combination of chemotherapy and radiotherapy.
The aim is to remove as much of the tumor as possible, since all studies have shown that the larger the excision, the better the prognosis and survival. However, excision is not always possible, particularly for tumors in highly functional areas. In this case, we prefer to first perform a biopsy to determine the exact nature of the tumor, before considering an operation to remove the tumor if necessary and possible. In all cases, the sample is analyzed by the neuropathologist (Prof. Homa Adle-Biassette and Dr. Marc Polivka) and the result is obtained in around a week.
The extent of resection is planned during the preoperative discussion with the patient, an essential moment for analyzing the foreseeable impact of the resection on the patient’s socio-professional life. For example, for tumors of the same frontal location, the limits will not be the same depending on whether the patient is a sports teacher (which means respecting the circuits of movement coordination) or an English teacher (which means respecting the circuits of the two spoken and written languages, French and English).
Surgery under awake conditions
is currently the most reliable technique for assisting the surgeon in localizing these functional limits. Prof. Emmanuel Mandonnet, the referent for this type of surgery, is an internationally recognized expert in awake surgery and the management of gliomas.
A follow-up imaging scan is performed after the procedure, usually within 48 hours, to confirm the extent of tumor exegesis.
It then takes 5 to 10 days to obtain the final results of the analysis of the removed tumor.
Depending on the type and grade of the tumour, additional treatment with radiotherapy, chemotherapy or targeted therapy may be proposed. In high-grade tumors, such as glioblastomas, radiotherapy and targeted chemotherapy and/or therapy is virtually routine.