DESCRIPTION:

This presentation examines the evolving role of surgery in the management of adult diffuse low-grade gliomas within the contemporary molecular era. It reviews the natural history and biological heterogeneity of these tumors, the prognostic importance of postoperative residual volume, and the emerging evidence supporting early, maximal-and in selected patients, supramaximal-resection. Particular emphasis is placed on awake cortical and subcortical mapping as a strategy for extending resection within motor, sensory, and language networks while preserving neurological and cognitive function. Illustrative clinical experience and emerging brain-computer interface technologies will be used to explore how increasing precise functional mapping may refine the integration of surgery with radiation therapy and systemic treatment in individualized, multidisciplinary care.

LEARNING OBJECTIVES:

• Review the natural history and clinical behavior of incidental and symptomatic diffuse gliomas.
• Explain the rationale for early surgical intervention and maximal safe resection in patients with intrinsic brain tumors.
• Describe contemporary strategies for maximizing resection while preserving neurological function, including advanced imaging, intraoperative guidance, cortical and subcortical mapping, and neurophysiological monitoring.