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This Article Full Text Full Text (PDF) Probabilistic Maps All Versions of this Article: 9/1/63    most recent 15228517-2006-015v2 15228517-2006-015v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Mandonnet, E. Articles by Duffau, H. Search for Related Content PubMed PubMed Citation

Preoperative estimation of residual volume for WHO grade II glioma resected with intraoperative functional mapping

Departments of Neurosurgery (E.M., L.C., H.D.) and Neuroradiology (D.G.), Hôpital de la Pitié-Salpêtrière, 75651 Paris; UMR-S678 Institut National de la Santé et de la Recherche Médicale (E.M., S.J., L.C., H.B., H.D.), 75654 Paris; and Department of Neurology, Centre Hospitalier Universitaire Nancy, 54000 Nancy (L.T.); France

¹ Address correspondence to Hugues Duffau, Department of Neurosurgery, UMR-S678 Inserm, Hôpital Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France (hugues.duffau{at}psl.ap-hop-paris.fr).

Despite the lack of class I evidence, it is widely agreed that surgery can improve the functional and vital prognosis for WHO grade II gliomas when the resection is at least subtotal radiologically, that is, leaving less than 10 cm³ of visible residual tumor. Because these tumors frequently invade functional areas, the preoperative estimation of the probable residual volume remains challenging. This article presents a probabilistic map of postoperative residues, with the aim of predicting before the decision for surgical intervention whether the resection could be subtotal. We selected 65 patients who underwent surgery with intraoperative functional mapping between 1999 and 2004 for a WHO grade II glioma located in a sensorimotor and/or language area. For each case, the postoperative image was normalized on a standard atlas, and the residual tumor was segmented. A probabilistic map of residues was then computed. The fusion between the map and a preoperative image allowed a preoperative estimation of the expected extent of resection. The map enhances the regions where grade II glioma cannot be resected. The success rate for the preoperative classification of partial versus subtotal resection is 82%. Although both its reliability and accuracy have to be improved, this probabilistic map gives preoperatively an objective estimation of the expected extent of resection for grade II glioma resected under intraoperative functional mapping. This rationale will assist in decisions regarding surgical resection and may thus contribute to the elaboration of a therapeutic consensus for WHO grade II glioma.

Key Words: grade II glioma • intraoperative mapping • probabilistic map

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