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**17** 

*Italy* 

**Multimodal Approach to the Surgical Removal** 

*3CCS fMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin* 

Supratentorial glial neoplasms are the most common primary brain tumor in adults and one of the leading causes of cancer-related death in the general population. Glioblastomas carry the worst prognosis, while low-grade gliomas have the best chance for survival. It has been demonstrated, however, that low-grade gliomas represent a precancerous state, as they have the potential to evolve into higher-grade malignancies. Although management algorithms vary among different types of tumors, surgery remains the mainstay of treatment for several reasons. Surgical resection allows the opportunity to obtain a sufficient amount of tumor for histological identification. This point is of utmost importance, as the best predictors of survival are the World Health Organization (WHO) grade and other immunohistological characteristics of the tumor. Additionally, it has been demonstrated that radical or subtotal resection correlates positively with prolongation of survival and longer time to progression. Given this information, neurosurgeons aim to achieve maximal surgical resection of these tumors whenever feasible. Unfortunately, gliomas are often located in regions of the brain defined as "eloquent" or "critical," meaning that physical damage to these areas can create permanent neurological deficits. A careful evaluation of surgical strategy is mandatory in light of this fact, with the goal being to maximize tumor resection while respecting the

Different techniques are available that allow the neurosurgeon to study the brain function topography both preoperatively and intraoperatively. These methods of preoperative and intraoperative brain mapping are used to gain essential information about functional and topographic organization in a specific patient. Functional magnetic resonance imaging (fMR) is the most commonly used tool for preoperative visualization of the motor, sensory, language, and visual functional organization of a patient's brain. Since gliomas typically invade white matter, the extent of resection is additionally limited by the degree of infiltration, particularly when critical bundles are involved (e.g., the pyramidal tract). As with the eloquent cortical areas, the relationship of the tumor to the subcortical pathways should be defined in order to avoid permanent deficits. Diffusion tensor imaging (DTI), the

highly functional cortical and subcortical regions of the brain.

**1. Introduction**

**of Gliomas in Eloquent Brain Regions** 

*2Division of Neurology and Neuropsychology, Civil Hospital, Alessandria,* 

Giannantonio Spena1, Antonio Pepoli2, Marcella Bruno2, Federico D'Agata3, Franco Cauda3, Katiuscia Sacco3,

*1Division of Neurosurgery, Civil Hospital, Alessandria* 

Sergio Duca3 and Pietro Versari1

Molecular targeting and treatment of an epidermal growth factor receptor-positive glioma using boronated cetuximab. *Clin Cancer Res,* Vol. 13, No. 4 pp. (1260-1268), ISSN. 1078-0432

