Refinement of neurosurgical technique has enabled safer operations with more aggressive outcomes. One cornerstone of modern-day practice is the utilization of intraoperative stimulation mapping. In addition to identifying critical motor pathways, this technique can be adapted to reliably identify language pathways. Given the individual variability of cortical language localization, such awake language mapping is essential to minimize language deficits following tumor resection. Our experience suggests that cortical language mapping is a safe and efficient adjunct to optimize tumor resection while preserving essential language sites, even in the setting of negative mapping data. However, the value of maximizing glioma resections remains surprisingly unclear, as there is no general consensus in the literature regarding the efficacy of extent of glioma resection in improving patient outcome. While the importance of resection in obtaining tissue diagnosis and alleviating symptoms is clear, a lack of Class I evidence prevents similar certainty in assessing the influence of extent of resection. Beyond an analysis of modern intraoperative mapping techniques, we examine every major clinical publication since 1990 on the role of extent of resection in glioma outcome. The mounting evidence suggests that, despite persistent limitations in the quality of available studies, a more extensive surgical resection is associated with longer life expectancy for both low-grade and high-grade gliomas.

中文翻译：

---

胶质瘤的手术技术和切除范围的价值。


神经外科技术的改进使得手术更加安全，结果更加积极。现代实践的基石之一是术中刺激映射的利用。除了识别关键运动通路之外，该技术还可以用于可靠地识别语言通路。考虑到皮质语言定位的个体差异，这种清醒语言映射对于最大限度地减少肿瘤切除后的语言缺陷至关重要。我们的经验表明，皮质语言映射是一种安全有效的辅助手段，可以优化肿瘤切除，同时保留重要的语言位点，即使在负映射数据的情况下也是如此。然而，令人惊讶的是，最大化神经胶质瘤切除术的价值仍然不清楚，因为文献中关于神经胶质瘤切除范围在改善患者预后方面的功效尚未达成普遍共识。虽然切除对于获得组织诊断和缓解症状的重要性是显而易见的，但缺乏 I 类证据阻碍了评估切除范围影响的类似确定性。除了对现代术中标测技术的分析之外，我们还检查了自 1990 年以来关于切除范围在神经胶质瘤结果中的作用的每一份主要临床出版物。越来越多的证据表明，尽管现有研究的质量持续受到限制，但更广泛的手术切除与低级别和高级别胶质瘤的预期寿命延长有关。