Update on surgery for diffuse low-grade gliomas: brain mapping, hodotopy and neuroplasticity

A better understanding of the natural history of diffuse low-grade gliomas (DLGG) and of their interaction with the mechanisms of reactive brain plasticity has led to a switch from a "wait and see "attitude to active therapeutic management. Advances in functional mapping techniques, both preoperatively (neuroimaging) and intraoperatively (awake surgery), have challenged the classical static and localizationist view of brain organization, in favor of a hodotopical model of parallel cortico-subcortical distributed and dynamic networks capable of compensating for one another. Early radical surgical resection is currently the first-line treatment for DLGG, because it delays anaplastic transformation and significantly increases median survival. It also preserves and may improve quality of life, even in patients whose gliomas involve eloquent areas, that were previously considered unresectable.