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Low-grade gliomas are a category of brain tumors that have a peculiarity: slow but progressive development. These tumors often appear linked to epileptic seizures, situations in which abnormal brain activity occurs that can trigger seizures.
Low-grade gliomas represent a considerable challenge for neurosurgeons due to their tendency to invade functional brain areas, significantly complicating treatment options.
The case recently addressed by the Hospital’s Neurosurgery Service University Quirónsalud Madrid illustrates this challenge. A patient had a glioma in the circle of the brain, a critical region that connects the limbic system, responsible for managing emotions, with the frontal and temporal cortices, which are essential for thought processing, planning and interpreting information. . .
As he explains Dr. Santiago Gil-Robleshead of the Neurosurgery Service of the Hospital University Quirónsalud Madrid“The complexity of this area lies in its involvement in a wide range of functions, from motor control of the leg to aspects as subtle and complex as empathy, decision making, emotional processing and self-awareness.”
Brain mapping
To prepare for this patient’s surgery, meticulous brain mapping was performed. This process is vital to accurately mark critical areas of the brain. The Diagnostic Imaging team, using functional magnetic resonance imaging, a cutting-edge technique in the field of neuroimaging, was able to precisely observe the areas of the brain active during specific tasks.
On this occasion, the patient was asked to participate in an empathy test and left leg movement exercises, which would identify the specific brain regions responsible for these important functions.
The surgery was a meticulous and highly technical process, executed in three carefully planned phases. The first phase consisted of anesthesia and preparation of the patient to access the affected brain area. In the second and most critical phase, the patient was woken up and asked to perform MRI-like tasks.
This innovative and thorough approach allowed surgeons to monitor and protect brain function in real time while tumor removal was carried out. If the patient made errors in the empathy test or showed difficulty moving the leg, it was a clear signal to stop resection or removal of the tumor, thereby minimizing the risk of irreversible damage to key brain areas.
The last phase of the surgery again involved anesthesia of the patient to finish the operation safely.
A comprehensive approach
The main objective of this surgical intervention was to remove as much of the tumor as possible without compromising the patient’s cognitive and motor functions. Since low-grade gliomas have the risk of becoming malignant or transforming into more aggressive and cancerous tumors over time, extensive and precise removal is essential to improve the patient’s long-term prognosis. This not only reduces the likelihood of tumor recurrence, but also decreases the chance of malignant transformation, thereby improving the patient’s life prospects.
This case is a clear example of how the combination of advanced imaging techniques with a meticulous and humanized surgical approach can make a significant difference in the treatment of gliomas. The use of fMRI and an adaptive surgical strategy, which respects key brain functions, not only maximizes tumor removal, but also protects the patient’s quality of life and identity. This comprehensive approach reflects a significant advance in the field of neurosurgery and could set a new standard for complex neurosurgical operations in the future, offering hope and new possibilities to patients with these types of diagnoses.