he classical approach to brain gliomas consisted in the surgical removal of a tumor located within a brain with a definitely fixed functional organization, while preserving structures commonly considered as crucial (e.g the rolandic, Broca’s and Wernicke’s areas). However, gliomas are frequently located near or within eloquent areas, and have a high capacity to infiltrate brain tissue. It is therefore mandatory to introduce new concepts in the management of these tumors. First, the inter-individual anatomo-functional variability in the organization of eloquent areas, hence, the necessity to map the brain in order to identify the functional regions in a individual patient. Second, since gliomas have a tendency to migrate along the white matter pathways, brain connectivity should be taken into account. Consequently, new techniques of anatomical tracking and functional mapping of the subcortical white matter pathways are used to study the individual effective connectivity. Third, cerebral plasticity, which is the dynamic potential of the brain to reorganize itself following injury. This explains the frequent lack of neurological deficits despite the growth of gliomas within eloquent areas, and this is also the underling mechanism that allows neurosurgeons to remove gliomas located within “high eloquent” areas.
In the last decade, the integration of these new concepts into the different disciplines implicated in glioma management (neuroimaging, surgery, radiotherapy, chemotherapy, etc), has dramatically changed the approach to these tumors. Perioperative neurofunctional imaging (functional magnetic resonance, positron emission tomography, magnetoencephalography, etc.) enable to study the cortical functional organization of an individual patient. Due to the recent development of diffusion tensor imaging tractography, it is now possible to track non-invasively in vivo the subcortical fibers, helping us to understand the three dimensional relationships between each white matter tract and the tumor. Intraoperative electrical stimulation has become the gold standard for all the other mapping techniques, as it had demonstrated to be a safe, accurate and reliable tool to identify and consequently preserve the cortical and subcortical functional boundaries in each step of tumor resection. In addition, due to the application of these new concepts to the radiotherapy and chemotherapy treatments, new questions have raised: If the surgical resection of the glioma has been pushed until the functional limits, which is the best radiotherapy strategy to avoid damaging the eloquent areas located within the walls of the surgical cavity?. Using preoperative chemotherapy which induce a shrink of the tumor, is it possible to achieve a radical resection of an “unresectable glioma”?
In the present congress, these and other questions will be analyzed, with the intention to give a new perspective in glioma management. This new approach considers, as the traditional view, the necessity to deal with the tumoral tissue, but it also emphasizes the necessity to identify and preserve the functional brain that surrounds the tumor. This new approach may allow to increase the surgical indications in gliomas within eloquent areas, maximize the quality of glioma resection, increase the neuro-oncological impact of the complementary treatments and minimize the neurological squealae, while preserving the quality of life.
We hope that the program proposed will be of interest for all the professionals involved in the management of patients with a brain glioma.
The congress will be held in the prestigious Palacio de la Magdalena, by the Sardinero beaches, in the heart of the city of Santander.
We look forward to welcoming you in Santander.
The Scientific Secretariat